Methods and compositions for the assessment of cardiovascular function and disorders

ABSTRACT

The present invention provides methods for the assessment of risk of developing acute coronary syndrome (ACS) in smokers and non-smokers using analysis of genetic polymorphisms. The present invention also relates to the use of genetic polymorphisms in assessing a subject&#39;s risk of developing ACS. Nucleotide probes and primers, kits, and microarrays suitable for such assessment are also provided.

FIELD OF THE INVENTION

The present invention is concerned with methods for assessment of vascular function and/or disorders, and in particular for diagnosing predisposition to and/or severity of coronary artery disease and particularly acute coronary syndrome (ACS) using analysis of genetic polymorphisms and altered gene expression. The present invention is also concerned with methods for diagnosing predisposition to and/or severity of ACS-associated impaired vascular function.

BACKGROUND OF THE INVENTION

Coronary artery disease (CAD), also known as coronary heart disease or arteriosclerotic heart disease, is the leading cause of death in the United States. According to the American Heart Association, about every 29 seconds someone in the US suffers from a CAD-related event, and about every minute someone dies from such an event. The lifetime risk of having coronary heart disease after age 40 is 49% for men and 32% for women. As women age, the risk increases almost to that of men. Furthermore, the total annual cost of CAD in the United States is approximately US$130 billion.

The cardiovascular disorders that underlie CAD can be divided into two groups, as indeed can the sufferers of such disorders. This is thought to reflect different etiology of the disorders. The disorders of the first group, herein referred to as “Stable CAD”, are degenerate in nature and include the late onset and exertional anginas. Stable CAD typically afflicts older persons, and is associated with age (65 and greater), high blood pressure, diabetes, high cholesterol levels (specifically, high LDL cholesterol and low HDL cholesterol), lack of physical activity or exercise, and obesity.

The disorders of the second group, herein referred to as acute coronary syndrome (ACS), are believed to be associated with inflammation, plaque instability, and/or smoking. ACS includes myocardial infarction and unstable angina. The Applicants believe, without wishing to be bound by any theory, that, more so than in Stable CAD, genetic risk factors are significant in susceptibility to and/or severity of ACS.

Moreover, the Applicants believe, again without wishing to be bound by any theory, that the biomarkers associated with Stable CAD are unlikely to be associated with, or predictive of, risk of ACS, and vice versa.

It would be desirable and advantageous to have biomarkers which could be used to assess a subject's risk of developing acute coronary syndrome (ACS), or risk of developing ACS-associated impaired vascular function, particularly if the subject is a smoker.

It is primarily to such biomarkers and their use in methods to assess risk of developing such disorders that the present invention is directed.

BRIEF DESCRIPTION OF THE INVENTION

The present invention is primarily directed to determining the association between genotypes and the subject's risk of developing acute coronary syndrome (ACS). As used herein, ACS includes but is not limited to myocardial infarction, unstable angina, and related acute coronary syndromes.

Thus, according to one aspect there is provided a method of determining a subject's risk of developing ACS comprising analysing a sample from said subject for the presence or absence of one or more polymorphisms selected from the group consisting of:

-   -   −1903 A/G in the gene encoding Chymase 1 (CMA1);     -   −82 A/G in the gene encoding Matrix metalloproteinase 12         (MMP12);     -   Ser52Ser (223 C/T) in the gene encoding Fibroblast growth factor         2 (FGF2);     -   Q576R A/G in the gene encoding Interleukin 4 receptor alpha         (IL4RA);     -   HOM T2437C in the gene encoding Heat Shock Protein 70 (HSP 70);     -   874 A/T in the gene encoding Interferon γ (IFNG);     -   −589 C/T in the gene encoding Interleukin 4 (IL-4);     -   −1084 A/G (−1082) in the gene encoding Interleukin 10 (IL-10);     -   Arg213Gly C/G in the gene encoding Superoxide dismutase 3         (SOD3);     -   459 C/T Intron I in the gene encoding Macrophage inflammatory         protein 1 alpha (MIP1A);     -   Asn 125 Ser A/G in the gene encoding Cathepsin G;     -   I249V C/T in the gene encoding Chemokine (CX3C motif) receptor 1         (CX3CR1);     -   Gly 881 Arg G/C in the gene encoding Caspase (NOD2); or     -   372 T/C in the gene encoding Tissue inhibitor of         metalloproteinase 1 (TIMP1);

wherein the presence or absence of one or more of said polymorphisms is indicative of the subject's risk of developing ACS.

The one or more polymorphisms can be detected directly or by detection of one or more polymorphisms which are in linkage disequilibrium with said one or more polymorphisms.

Linkage disequilibrium (LD) is a phenomenon in genetics whereby two or more mutations or polymorphisms are in such close genetic proximity that they are co-inherited. This means that in genotyping, detection of one polymorphism as present infers the presence of the other. (Reich D E et al; Linkage disequilibrium in the human genome, Nature 2001, 411:199-204.)

The method can additionally comprise analysing a sample from said subject for the presence of one or more further polymorphisms selected from the group consisting of:

-   -   −509 C/T in the gene encoding Transforming growth factor β1         (TGFB1);     -   Thr26Asn A/C in the gene encoding Lymphotoxin α (LTA);     -   Asp299Gly A/G in the gene encoding Toll-like Receptor 4 (TLR4);     -   Thr399Ile C/T in the gene encoding TLR4;     -   −63 T/A in the gene encoding Nuclear factor of kappa light         polypeptide gene enhancer in B-cells inhibitor-like 1 (NFKBIL1);     -   −1630 Ins/Del (AACTT/Del) in the gene encoding Platelet derived         growth factor receptor alpha (PDGFRA);     -   −1607 1G/2G (Del/G) in the gene encoding Matrix         metalloproteinase 1 (MMP1);     -   12 IN 5 C/T in the gene encoding Platelet derived growth factor         alpha (PDGFA);     -   −588 C/T in the gene encoding Glutamate-cysteine ligase modifier         subunit (GCLM);     -   Ile32Val A/G in the gene encoding Olfactory receptor analogue         OR13G1 (OR13G1);     -   Glu288Val A/T (M/S) in the gene encoding alpha 1-antitrypsin         (α1-AT);     -   K469E A/G in the gene encoding Intracellular adhesion molecule 1         (ICAM1);     -   −23 C/G in the gene encoding HLA-B associated transcript 1         (BAT1);     -   Glu298Asp G/T in the gene encoding Nitric Oxide synthase 3         (NOS3);     -   −668 4G/5G in the gene encoding Plasminogen activator inhibitor         1 (PAI-1); or     -   −A/G in the gene encoding Matrix metalloproteinase 7 (MMP7).

Again, detection of the one or more further polymorphisms may be carried out directly or by detection of polymorphisms in linkage disequilibrium with the one or more further polymorphisms.

-   -   The presence of one or more polymorphisms selected from the         group consisting of:     -   the Ser52Ser (223 C/T) CC genotype in the gene encoding FGF2;     -   the Q576R A/G AA genotype in the gene encoding IL4RA;     -   the Thr26Asn A/C CC genotype in the gene encoding LTA;     -   the Hom T2437C CC or CT genotype in the gene encoding HSP70;     -   the Asp299Gly A/G AG or GG genotype in the gene encoding TLR4;     -   the Thr399Ile C/T CT or TT genotype in the gene encoding TLR4;     -   the 874 A/T TT genotype in the gene encoding IFNG;     -   the −63 T/A AA genotype in the gene encoding NFKBIL1;     -   the −1630 Ins/Del (AACTT/Del) Ins/Del or Del/Del genotype in the         gene encoding PDGFRA;     -   the −589 C/T CT or TT genotype in the gene encoding IL-4;     -   the −588 C/T CC genotype in the gene encoding GCLM;     -   the −1084 A/G GG genotype in the gene encoding IL-10;     -   the K469E A/G AA genotype in the gene encoding ICAM1;     -   the −23 C/G GG genotype in the gene encoding BAT1;     -   the Glu298Asp G/T GG genotype in the gene encoding NOS3;     -   the Arg213Gly C/G CG or GG genotype in the gene encoding SOD3;     -   the −668 4G/5G 5G5G genotype in the gene encoding PAI-1;     -   the −181 A/G GG genotype in the gene encoding MMP7;     -   the Asn 125 Ser AG or GG genotype in the gene encoding Cathepsin         G; or     -   the 372 T/C TT genotype in the gene encoding TIMP1;         may be indicative of a decreased risk of developing ACS.

The presence of one or more polymorphisms selected from the group consisting of

-   -   the −1903 A/G GG genotype in the gene encoding CMA1;     -   the −509 C/T CC genotype in the gene encoding TGFB1;     -   the −82 A/G GG genotype in the gene encoding MMP12;     -   the Ser52Ser (223 C/T) CT or TT genotype in the gene encoding         FGF2;     -   the Q576R A/G GG genotype in the gene encoding IL4RA;     -   the Hom T2437C TT genotype in the gene encoding HSP70;     -   the Asp299Gly A/G AA genotype in the gene encoding TLR4;     -   the Thr399Ile C/T CC genotype in the gene encoding TLR4;     -   the −1630 Ins/Del (AACTT/Del) Ins Ins (AACTT AACTT) genotype in         the gene encoding PDGFRA;     -   the −589 C/T CC genotype in the gene encoding IL4;     -   the −1607 1G/2G (Del/G) Del Del (1G1G) genotype in the gene         encoding MMP1;     -   the 12 IN5 C/T TT genotype in the gene encoding PDGFA;     -   the −588 C/T CT or TT genotype in the gene encoding GCLM;     -   the Ile32Val A/G AA genotype in the gene encoding OR13G1;     -   the Glu288Val A/T (M/S) AT or TT (MS or SS) genotype in the gene         encoding α1-AT;     -   the +459 C/T Intron 1 CT or TT genotype in the gene encoding         MIP1A;     -   the Asn 125 Ser AA genotype in the gene encoding Cathepsin G;     -   the I249V TT genotype in the gene encoding CX3CR1;     -   the Gly 881 Arg G/C CC or CG genotype in the gene encoding NOD2;         or     -   the 372 T/C CC genotype in the gene encoding TIMP1; may be         indicative of an increased risk of developing ACS.

The methods of the invention are particularly useful in smokers (both current and former).

It will be appreciated that the methods of the invention identify two categories of polymorphisms—namely those associated with a reduced risk of developing ACS (which can be termed “protective polymorphisms”) and those associated with an increased risk of developing ACS (which can be termed “susceptibility polymorphisms”).

Therefore, the present invention further provides a method of assessing a subject's risk of developing ACS, said method comprising:

determining the presence or absence of at least one protective polymorphism associated with a reduced risk of developing ACS; and

in the absence of at least one protective polymorphism, determining the presence or absence of at least one susceptibility polymorphism associated with an increased risk of developing ACS;

wherein the presence of one or more of said protective polymorphisms is indicative of a reduced risk of developing ACS, and the absence of at least one protective polymorphism in combination with the presence of at least one susceptibility polymorphism is indicative of an increased risk of developing ACS.

Preferably, said at least one protective polymorphism is selected from the group consisting of:

The at least one susceptibility polymorphism may be selected from the group consisting of:

In a preferred form of the invention the presence of two or more protective polymorphisms is indicative of a reduced risk of developing ACS.

In a further preferred form of the invention the presence of two or more susceptibility polymorphisms is indicative of an increased risk of developing ACS.

In still a further preferred form of the invention the presence of two or more protective polymorphims irrespective of the presence of one or more susceptibility polymorphisms is indicative of reduced risk of developing ACS.

In another aspect, the invention provides a method of determining a subject's risk of developing ACS, said method comprising obtaining the result of one or more genetic tests of a sample from said subject, and analysing the result for the presence or absence of one or more polymorphisms selected from the group consisting of:

-   -   −1903 A/G in the gene encoding Chymase 1 (CMA1);     -   −82 A/G in the gene encoding Matrix metalloproteinase 12         (MMP12);     -   Ser52Ser (223 C/T) in the gene encoding Fibroblast growth factor         2 (FGF2);     -   Q576R A/G in the gene encoding Interleukin 4 receptor alpha         (IL4RA);     -   HOM T2437C in the gene encoding Heat Shock Protein 70 (HSP 70);     -   874 A/T in the gene encoding Interferon γ (IFNG);     -   −589 C/T in the gene encoding Interleukin 4 (IL-4);     -   −1084 A/G (−1082) in the gene encoding Interleukin 10 (IL-10);     -   Arg213Gly C/G in the gene encoding Superoxide dismutase 3         (SOD3);     -   459 C/T Intron I in the gene encoding Macrophage inflammatory         protein 1 alpha (MIP1A);     -   Asn 125 Ser A/G in the gene encoding Cathepsin G;     -   I249V C/T in the gene encoding Chemokine (CX3C motif) receptor 1         (CX3CR1);     -   Gly 881 Arg G/C in the gene encoding Caspase (NOD2); or     -   372 T/C in the gene encoding Tissue inhibitor of         metalloproteinase 1 (TIMP1); or one or more polymorphisms in         linkage disequilibrium with any one or more of these         polymorphisms;

wherein a result indicating the presence or absence of one or more of said polymorphisms is indicative of the subject's risk of developing ACS.

In a further aspect there is provided a method of determining a subject's risk of developing ACS comprising the analysis of two or more polymorphisms selected from the group consisting of:

-   -   −1903 A/G in the gene encoding Chymase 1 (CMA1);     -   −82 A/G in the gene encoding Matrix metalloproteinase 12         (MMP12);     -   Ser52Ser (223 C/T) in the gene encoding Fibroblast growth factor         2 (FGF2);     -   Q576R A/G in the gene encoding Interleukin 4 receptor alpha         (IL4RA);     -   HOM T2437C in the gene encoding Heat Shock Protein 70 (HSP 70);     -   874 A/T in the gene encoding Interferon γ (IFNG);     -   −589 C/T in the gene encoding Interleukin 4 (IL-4);     -   −1084 A/G (−1082) in the gene encoding Interleukin 10 (IL-10);     -   Arg213Gly C/G in the gene encoding Superoxide dismutase 3         (SOD3);     -   459 C/T Intron I in the gene encoding Macrophage inflammatory         protein 1 alpha (MIP1A);     -   −509 C/T in the gene encoding Transforming growth factor β1         (TGFB1);     -   Thr26Asn A/C in the gene encoding Lymphotoxin a (LTA);     -   Asp299Gly A/G in the gene encoding Toll-like Receptor 4 (TLR4);     -   Thr399Ile C/T in the gene encoding TLR4;     -   −63 T/A in the gene encoding Nuclear factor of kappa light         polypeptide gene enhancer in B-cells inhibitor-like 1 (NFKBIL1);     -   −1630 Ins/Del (AACTT/Del) in the gene encoding Platelet derived         growth factor receptor alpha (PDGFRA);     -   −1607 1G/2G (Del/G) in the gene encoding Matrix         metalloproteinase 1 (MMP1);     -   12 IN 5 C/T in the gene encoding Platelet derived growth factor         alpha (PDGFA);     -   −588 C/T in the gene encoding Glutamate-cysteine ligase modifier         subunit (GCLM);     -   Ile32Val A/G in the gene encoding Olfactory receptor analogue         OR13G1 (OR13G1);     -   Glu288Val A/T (M/S) in the gene encoding alpha 1-antitrypsin         (α1-AT);     -   K469E A/G in the gene encoding Intracellular adhesion molecule 1         (ICAM1);     -   −23 C/G in the gene encoding HLA-B associated transcript 1         (BAT1);     -   Glu298Asp G/T in the gene encoding Nitric Oxide synthase 3         (NOS3);     -   −668 4G/5G in the gene encoding Plasminogen activator inhibitor         1 (PAI-1); or     -   −181 A/G in the gene encoding Matrix metalloproteinase 7 (MMP7);     -   Asn 125 Ser A/G in the gene encoding Cathepsin G;     -   I249V C/T in the gene encoding Chemokine (CX3C motif) receptor 1         (CX3CR1);     -   Gly 881 Arg G/C in the gene encoding Caspase (NOD2); or     -   372 T/C in the gene encoding Tissue inhibitor of         metalloproteinase 1 (TIMP1); or one or more polymorphisms in         linkage disequilibrium with any one or more of these         polymorphisms.

In various embodiments, any one or more of the above methods comprises the step of analysing the amino acid present at a position mapping to codon 576 of the gene encoding IL4RA.

The presence of glutamine at said position is indicative of a reduced risk of developing ACS.

The presence of arginine at said position is indicative of an increased risk of developing ACS.

In various embodiments, any one or more of the above methods comprises the step of analysing the amino acid present at a position mapping to codon 26 of the gene encoding LTA.

The presence of threonine at said position is indicative of a decreased risk of developing ACS.

The presence of asparagine at said position is indicative of an increased risk of developing ACS.

In various embodiments, any one or more of the above methods comprises the step of analysing the amino acid present at a position mapping to codon 299 of the gene encoding TLR4.

The presence of glycine at said position is indicative of a decreased risk of developing ACS.

The presence of aspartate at said position is indicative of an increased risk of developing ACS.

In various embodiments, any one or more of the above methods comprises the step of analysing the amino acid present at a position mapping to codon 399 of the gene encoding TLR4.

The presence of isoleucine at said position is indicative of a decreased risk of developing ACS.

The presence of threonine at said position may be indicative of an increased risk of developing ACS.

In various embodiments, any one or more of the above methods comprises the step of analysing the amino acid present at a position mapping to codon 132 of the gene encoding OR13G1.

The presence of isoleucine at said position is indicative of an increased risk of developing ACS.

In various embodiments, any one or more of the above methods comprises the step of analysing the amino acid present at a position mapping to codon 288 of the gene encoding α1-AT.

The presence of glutamate at said position is indicative of an increased risk of developing ACS.

In various embodiments, any one or more of the above methods comprises the step of analysing the amino acid present at a position mapping to codon 496 of the gene encoding ICAM1.

The presence of lysine at said position is indicative of a decreased risk of developing ACS.

In various embodiments, any one or more of the above methods comprises the step of analysing the amino acid present at a position mapping to codon 298 of the gene encoding NOS3.

The presence of glutamate at said position is indicative of a decreased risk of developing ACS.

The presence of aspartate at said position is indicative of an increased risk of developing ACS.

In various embodiments, any one or more of the above methods comprises the step of analysing the amino acid present at a position mapping to codon 213 of the gene encoding SOD3.

The presence of glycine at said position is indicative of a decreased risk of developing ACS.

In various embodiments, any one or more of the above methods comprises the step of analysing the amino acid present at a position mapping to codon 125 of the gene encoding Cathespin G.

The presence of serine at said position is indicative of a decreased risk of developing ACS.

The presence of asparagine at said position is indicative of an increased risk of developing ACS.

In various embodiments, any one or more of the above methods comprises the step of analysing the amino acid present at a position mapping to codon 249 of the gene encoding CX3CR1.

The presence of isoleucine at said position is indicative of an increased risk of developing ACS.

In various embodiments, any one or more of the above methods comprises the step of analysing the amino acid present at a position mapping to codon 881 of the gene encoding NOD2.

The presence of arginine at said position is indicative of an increased risk of developing ACS.

In a preferred form of the invention the methods as described herein are performed in conjunction with an analysis of one or more risk factors, including one or more epidemiological risk factors, associated with a risk of developing ACS. Such epidemiological risk factors include but are not limited to smoking or exposure to tobacco smoke, age, sex, and familial history of ACS.

In a further aspect, the invention provides for the use of at least one polymorphism in the assessment of a subject's risk of developing ACS, wherein said at least one polymorphism is selected from the group consisting of:

-   -   −1903 A/G in the gene encoding Chymase 1 (CMA1);     -   −82 A/G in the gene encoding Matrix metalloproteinase 12         (MMP12);     -   Ser52Ser (223 C/T) in the gene encoding Fibroblast growth factor         2 (FGF2);     -   Q576R A/G in the gene encoding Interleukin 4 receptor alpha         (IL4RA);     -   HOM T2437C in the gene encoding Heat Shock Protein 70 (HSP 70);     -   874 A/T in the gene encoding Interferon γ (IFNG);     -   −589 C/T in the gene encoding Interleukin 4 (IL-4);     -   −1084 A/G (−1082) in the gene encoding Interleukin 10 (IL-10);     -   Arg213Gly C/G in the gene encoding Superoxide dismutase 3         (SOD3);     -   459 C/T Intron I in the gene encoding Macrophage inflammatory         protein 1 alpha (MIP1A);     -   Asn 125 Ser A/G in the gene encoding Cathepsin G;     -   I249V C/T in the gene encoding Chemokine (CX3C motif) receptor 1         (CX3CR1);     -   Gly 881 Arg G/C in the gene encoding Caspase (NOD2); or     -   372 T/C in the gene encoding Tissue inhibitor of         metalloproteinase 1 (TIMP1); or one or more polymorphisms in         linkage disequilibrium with any one of said polymorphisms.

Optionally, said use may be in conjunction with the use of at least one further polymorphism selected from the group consisting of:

-   -   −509 C/T in the gene encoding Transforming growth factor β1         (TGFB1);     -   Thr26Asn A/C in the gene encoding Lymphotoxin α (LTA);     -   Asp299Gly A/G in the gene encoding Toll-like Receptor 4 (TLR4);     -   Thr399Ile C/T in the gene encoding TLR4;     -   −63 T/A in the gene encoding Nuclear factor of kappa light         polypeptide gene enhancer in B-cells inhibitor-like 1 (NFKBIL1);     -   −1630 Ins/Del (AACTT/Del) in the gene encoding Platelet derived         growth factor receptor alpha (PDGFRA);     -   −1607 1G/2G (Del/G) in the gene encoding Matrix         metalloproteinase 1 (MMP1);     -   12 IN 5 C/T in the gene encoding Platelet derived growth factor         alpha (PDGFA);     -   −588 C/T in the gene encoding Glutamate-cysteine ligase modifier         subunit (GCLM);     -   Ile32Val A/G in the gene encoding Olfactory receptor analogue         OR13G1 (OR13G1);     -   Glu288Val A/T (M/S) in the gene encoding alpha 1-antitrypsin         (α1-AT);     -   K469E A/G in the gene encoding Intracellular adhesion molecule 1         (ICAM1);     -   −23 C/G in the gene encoding HLA-B associated transcript 1         (BAT1);     -   Glu298Asp G/T in the gene encoding Nitric Oxide synthase 3         (NOS3);     -   −668 4G/5G in the gene encoding Plasminogen activator inhibitor         1 (PAI-1);     -   −181 A/G in the gene encoding Matrix metalloproteinase 7 (MMP7);     -   or one or more polymorphisms which are in linkage disequilibrium         with any one or more of these polymorphisms.

In another aspect the invention provides a set of nucleotide probes and/or primers for use in the preferred methods of the invention herein described. Preferably, the nucleotide probes and/or primers are those which span, or are able to be used to span, the polymorphic regions of the genes. Also provided are one or more nucleotide probes and/or primers comprising the sequence of any one of the probes and/or primers herein described, including any one comprising the sequence of any one of SEQ.ID.NO. 1 to 124.

In yet a further aspect, the invention provides a nucleic acid microarray for use in the methods of the invention, which microarray comprises a substrate presenting nucleic acid sequences capable of hybridizing to nucleic acid sequences which encode one or more of the susceptibility or protective polymorphisms described herein or sequences complimentary thereto.

In another aspect, the invention provides an antibody microarray for use in the methods of the invention, which microarray comprises a substrate presenting antibodies capable of binding to a product of expression of a gene the expression of which is upregulated or downregulated when associated with a susceptibility or protective polymorphism as described herein.

In a further aspect the present invention provides a method treating a subject having an increased risk of developing ACS comprising the step of replicating, genotypically or phenotypically, the presence and/or functional effect of a protective polymorphism in said subject.

In yet a further aspect, the present invention provides a method of treating a subject having an increased risk of developing ACS, said subject having a detectable susceptibility polymorphism which either upregulates or downregulates expression of a gene such that the physiologically active concentration of the expressed gene product is outside a range which is normal for the age and sex of the subject, said method comprising the step of restoring the physiologically active concentration of said product of gene expression to be within a range which is normal for the age and sex of the subject.

In a further aspect the present invention provides a method of treating a subject having an increased risk of developing ACS due to the presence of a polymorphism predictive of susceptibility to ACS comprising the step of reversing, genotypically or phenotypically, the functional effect of said polymorphism in said subject.

In yet still a further aspect the present invention provides a method of treating a subject having an increased risk of developing ACS and for whom the presence of the GG genotype at the −82 A/G polymorphism in the promoter of the gene encoding MMP12 has been determined, said method comprising administering to said subject an agent capable of modulating MMP12 activity in said subject.

In one embodiment, said agent is an agent capable of increasing expression of or the activity of one or more tissue inhibitors of metalloproteinases (TIMPs), preferably the expression or activity of one or more of TIMP1, TIMP2, TIMP3, or TIMP4. In a further embodiment, said agent is an agent capable of reducing expression of or the activity of one or more membrane bound MMPs. In still a father embodiment, said agent is a MMP inhibitor, preferably said MMP inhibitor is selected from the group comprising 4,5-dihydroxyanthaquinone-2-carboxylic acid (AQCA), anthraquinyl-mercaptoethyamine, anthraquinyl-alanine hydroxamate, and derivatives thereof.

In yet still a further aspect the present invention provides a method of treating a subject having an increased risk of developing ACS and for whom the presence of the CC genotype at the 372 T/C polymorphism in the gene encoding TIMP1 has been determined, said method comprising administering to said subject an agent capable of modulating TIMP1 activity in said subject.

In one embodiment, said agent is an agent capable of increasing expression of or the activity of TIMP1.

In yet a further aspect, the present invention provides a method for screening for compounds that modulate the expression and/or activity of a gene, the expression of which is upregulated or downregulated when associated with a susceptibility or protective polymorphism (as compared to the level of expression of said gene when not associated with said polymorphism), said method comprising the steps of:

contacting a candidate compound with a cell comprising a susceptibility or protective polymorphism which has been determined to be associated with the upregulation or downregulation of expression of a gene; and

measuring the expression of said gene following contact with said candidate compound,

wherein a change in the level of expression after the contacting step as compared to before the contacting step is indicative of the ability of the compound to modulate the expression and/or activity of said gene.

Preferably, said cell is a human vascular cell, more preferably a human vascular epithelial cell, which has been pre-screened to confirm the presence of said polymorphism.

Preferably, said cell comprises a susceptibility polymorphism associated with upregulation of expression of said gene and said screening is for candidate compounds which downregulate expression of said gene.

Alternatively, said cell comprises a susceptibility polymorphism associated with downregulation of expression of said gene and said screening is for candidate compounds which upregulate expression of said gene.

In another embodiment, said cell comprises a protective polymorphism associated with upregulation of expression of said gene and said screening is for candidate compounds which further upregulate expression of said gene.

Alternatively, said cell comprises a protective polymorphism associated with downregulation of expression of said gene and said screening is for candidate compounds which further downregulate expression of said gene.

In another aspect, the present invention provides a method for screening for compounds that modulate the expression and/or activity of a gene, the expression of which is upregulated or downregulated when associated with a susceptibility or protective polymorphism, said method comprising the steps of:

contacting a candidate compound with a cell comprising a gene, the expression of which is upregulated or downregulated when associated with a susceptibility or protective polymorphism but which in said cell the expression of which is neither upregulated nor downregulated; and

measuring the expression of said gene following contact with said candidate compound,

wherein a change in the level of expression after the contacting step as compared to before the contacting step is indicative of the ability of the compound to modulate the expression and/or activity of said gene.

Preferably, expression of the gene is downregulated when associated with a susceptibility polymorphism once said screening is for candidate compounds which in said cell, upregulate expression of said gene.

Preferably, said cell is a human vascular cell, more preferably a human vascular epithelial cell, which has been pre-screened to confirm the presence, and baseline level of expression, of said gene.

Alternatively, expression of the gene is upregulated when associated with a susceptibility polymorphism and said screening is for candidate compounds which, in said cell, downregulate expression of said gene.

In another embodiment, expression of the gene is upregulated when associated with a protective polymorphism and said screening is for compounds which, in said cell, upregulate expression of said gene.

Alternatively, expression of the gene is downregulated when associated with a protective polymorphism and said screening is for compounds which, in said cell, downregulate expression of said gene.

In yet a further aspect, the present invention provides a method of assessing the likely responsiveness of a subject at risk of developing or suffering from ACS to a prophylactic or therapeutic treatment, which treatment involves restoring the physiologically active concentration of a product of gene expression to be within a range which is normal for the age and sex of the subject, which method comprises detecting in said subject the presence or absence of a susceptibility polymorphism which when present either upregulates or downregulates expression of said gene such that the physiological active concentration of the expressed gene product is outside said normal range, wherein the detection of the presence of said polymorphism is indicative of the subject likely responding to said treatment.

In a further aspect, the present invention provides a kit for assessing a subject's risk of developing ACS, said kit comprising a means of analysing a sample from said subject for the presence or absence of one or more polymorphisms disclosed herein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1: depicts a graph showing the frequency of ACS plotted against SNP score derived from the 11 SNP panel.

FIG. 2: depicts a graph showing the frequency of ACS plotted against the SNP score derived from the 15 SNP panel.

FIG. 3 depicts a graph showing the log odds of having ACS according to SNP score derived from the 11 SNP panel.

FIG. 4 depicts a graph showing the frequency of ACS against SNP score derived from the substituted 11 SNP panel.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

Using case-control studies the frequencies of several genetic variants (polymorphisms) of candidate genes in smokers who have developed ACS and blood donor controls have been compared. The majority of these candidate genes have confirmed (or likely) functional effects on gene expression or protein function. Specifically, the frequencies of polymorphisms between blood donor controls, resistant smokers and those with ACS have been compared.

In one embodiment described herein 20 susceptibility genetic polymorphisms and 20 protective genetic polymorphisms are identified. These are as follows:

Gene Polymorphism Genotype Phenotype CMA1 −1903 A/G GG susceptibility TGFB1 −509 C/T CC susceptibility MMP12 −82 A/G GG susceptibility FGF2 Ser52Ser 223 C/T CT/TT susceptibility CC protective IL4RA Q576R A/G GG susceptibility AA protective LTA Thr26Asn A/C CC protective HSP70 Hom T2437C CC/CT protective TT susceptibility TLR4 Asp299Gly A/G AG/GG protective AA susceptibility TLR4 Thr399Ile C/T CT/TT protective CC susceptibility IFNG 874 A/T TT protective NFKBIL1 −63 T/A AA protective PDGFRA −1630 I/D, AACTT/Del I/Del, protective Del/Del susceptibility II IL4 −589 C/T CT/TT protective CC susceptibility MMP1 −1607 1G/2G, Del/G Del.Del susceptibility ie 1G1G PDGFA 12 IN5 C/T TT susceptibility GCLM −588 C/T CT/TT susceptibility CC protective OR13G1 Ile132Val A/G AA susceptibility IL-10 −1084 A/G (−1082) GG protective α1-AT Glu288Val A/T (M/S) AT/TT susceptibility S allele MS/SS ICAM1 K469E A/G AA protective BAT1 −23 C/G GG protective NOS3 Glu298Asp G/T GG protective SOD3 Arg213Gly C/G CG/GG protective PAI-1 −668 4G/5G 5G5G protective MIP1A +459 C/T Intron 1 CT/TT susceptibility MMP7 −181 A/G GG protective Cathepsin G Asn 125Ser AG/GG protective AA susceptibility CX3CR1 I249V TT susceptibility NOD2 Gly 881 Arg G/C CC/CG susceptibility TIMP1 372 T/C TT protective CC susceptibility

A susceptibility genetic polymorphism is one which, when present, is indicative of an increased risk of developing ACS. In contrast, a protective genetic polymorphism is one which, when present, is indicative of a reduced risk of developing ACS.

As used herein, the phrase “risk of developing ACS” means the likelihood that a subject to whom the risk applies will develop ACS, and includes predisposition to, and potential onset of the disease. Accordingly, the phrase “increased risk of developing ACS” means that a subject having such an increased risk possesses an hereditary inclination or tendency to develop ACS. This does not mean that such a person will actually develop ACS at any time, merely that he or she has a greater likelihood of developing ACS compared to the general population of individuals that either does not possess a polymorphism associated with increased ACS or does possess a polymorphism associated with decreased ACS risk. Subjects with an increased risk of developing ACS include those with a predisposition to ACS, such as a tendency or predilection regardless of their vascular function at the time of assessment, for example, a subject who is genetically inclined to ACS but who has normal vascular function, those at potential risk, including subjects with a tendency to mildly reduced vascular function who are likely to go on to suffer ACS if they keep smoking, and subjects with potential onset of ACS, who have a tendency to poor vascular function consistent with ACS at the time of assessment.

Similarly, the phrase “decreased risk of developing ACS” means that a subject having such a decreased risk possesses an hereditary disinclination or reduced tendency to develop ACS. This does not mean that such a person will not develop ACS at any time, merely that he or she has a decreased likelihood of developing ACS compared to the general population of individuals that either does possess one or more polymorphisms associated with increased ACS, or does not possess a polymorphism associated with decreased ACS.

It will be understood that in the context of the present invention the term “polymorphism” means the occurrence together in the same population at a rate greater than that attributable to random mutation (usually greater than 1%) of two or more alternate forms (such as alleles or genetic markers) of a chromosomal locus that differ in nucleotide sequence or have variable numbers of repeated nucleotide units. See www.ornl.gov/sci/techresources/Human_Genome/publicat/97pr/09gloss.html#p. Accordingly, the term “polymorphisms” is used herein contemplates genetic variations, including single nucleotide substitutions, insertions and deletions of nucleotides, repetitive sequences (such as microsatellites), and the total or partial absence of genes (eg. null mutations). As used herein, the term “polymorphisms” also includes genotypes and haplotypes. A genotype is the genetic composition at a specific locus or set of loci. A haplotype is a set of closely linked genetic markers present on one chromosome which are not easily separable by recombination, tend to be inherited together, and may be in linkage disequilibrium. A haplotype can be identified by patterns of polymorphisms such as SNPs. Similarly, the term “single nucleotide polymorphism” or “SNP” in the context of the present invention includes single base nucleotide substitutions and short deletion and insertion polymorphisms.

A reduced or increased risk of a subject developing ACS may be diagnosed by analysing a sample from said subject for the presence of a polymorphism selected from the group consisting of:

-   -   −1903 A/G in the gene encoding Chymase 1 (CMA1);     -   −82 A/G in the gene encoding Matrix metalloproteinase 12         (MMP12);     -   Ser52Ser (223 C/T) in the gene encoding Fibroblast growth factor         2 (FGF2);     -   Q576R A/G in the gene encoding Interleukin 4 receptor alpha         (IL4RA);     -   HOM T2437C in the gene encoding Heat Shock Protein 70 (HSP 70);     -   874 A/T in the gene encoding Interferon γ (IFNG);     -   −589 C/T in the gene encoding Interleukin 4 (IL-4);     -   −1084 A/G (−1082) in the gene encoding Interleukin 10 (IL-10);     -   Arg213Gly C/G in the gene encoding Superoxide dismutase 3         (SOD3);     -   459 C/T Intron I in the gene encoding Macrophage inflammatory         protein 1 alpha (MIP1A);     -   Asn 125 Ser A/G in the gene encoding Cathepsin G;     -   I249V C/T in the gene encoding Chemokine (CX3C motif) receptor 1         (CX3CR1);     -   Gly 881 Arg G/C in the gene encoding Caspase (NOD2); or

372 T/C in the gene encoding Tissue inhibitor of metalloproteinase 1 (TIMP1); or one or more polymorphisms which are in linkage disequilibrium with any one or more of the above group.

These polymorphisms can also be analysed in combinations of two or more, or in combination with other polymorphisms indicative of a subject's risk of developing ACS, inclusive of the remaining polymorphisms listed above.

Assays which involve combinations of polymorphisms, including those amenable to high throughput, such as those utilising microarrays, are preferred.

Statistical analyses, particularly of the combined effects of these polymorphisms, show that the genetic assays of the present invention can be used to determine the risk quotient of any subject (including smokers) and in particular to identify subjects at greater risk of developing ACS. Such combined analysis can be of combinations of susceptibility polymorphisms only, of protective polymorphisms only, or of combinations of both. Analysis can also be step-wise, with analysis of the presence or absence of protective polymorphisms occurring first and then with analysis of susceptibility polymorphisms proceeding only where no protective polymorphisms are present.

Thus, through systematic analysis of the frequency of these polymorphisms in well defined groups of subjects including smokers and non-smokers as described herein, it is possible to implicate certain genes and proteins in the development of ACS and improve the ability to identify which subjects are at increased risk of developing ACS-related impaired vascular function and ACS for predictive purposes.

The present results show that the minority of smokers who develop ACS do so because they have one or more of the susceptibility polymorphisms and few or none of the protective polymorphisms defined herein. It is thought that the presence of one or more susceptibility polymorphisms, together with the damaging irritant and oxidant effects of smoking, combine to make this group of smokers highly susceptible to developing ACS. Additional risk factors, such as familial history, age, weight, pack years, etc., will also have an impact on the risk profile of a subject, and can be assessed in combination with the genetic analyses described herein.

The one or more polymorphisms can be detected directly or by detection of one or more polymorphisms which are in linkage disequilibrium with said one or more polymorphisms. As discussed above, linkage disequilibrium is a phenomenon in genetics whereby two or more mutations or polymorphisms are in such close genetic proximity that they are co-inherited. This means that in genotyping, detection of one polymorphism as present infers the presence of the other. (Reich D E et al; Linkage disequilibrium in the human genome, Nature 2001, 411:199-204.)

Examples of polymorphisms described herein that have been reported to be in linkage disequilibrium are presented herein, and include the MMP12-82 A/G and MMP1−1607 1G/2G (Del/G) polymorphisms, the LTA Thr26Asn A/C and NFKBIL1-63 T/A polymorphsisms, and the TLR4 Asp299Gly A/G and Thr399Ile C/T polymorphisms as shown herein in Example 2 and Table 33.

It will be apparent that polymorphsisms in linkage disequilibrium with one or more other polymorphism associated with increased or decreased risk of developing ACS will also provide utility as biomarkers for risk of developing ACS. The data presented herein shows that the frequency for SNPs in linkage disequilibrium is very similar. Accordingly, these genetically linked SNPs can be utilized in combined polymorphism analyses to derive a level of risk comparable to that calculated from the original SNP. An example of such an analysis in which SNPs in LD are substituted one for the other is presented herein in Example 2.

It will therefore be apparent that one or more polymorphisms in linkage disequilibrium with the polymorphisms specified herein can be identified, for example, using public data bases. Examples of such polymorphisms reported to be in linkage disequilibrium with the polymorphisms specified herein are presented herein in Table 35.

It will also be apparent that frequently a variety of nomenclatures may exist for any given polymorphism. For example, the polymorphism referred to herein as Arg 213 Gly in the gene encoding SOD3 is believed to have been referred to variously as Arg 312 Gln, +760 G/C, and Arg 231 Gly (rs1799895). When referring to a susceptibility or protective polymorphism as herein described, such alternative nomenclatures are also contemplated by the present invention.

The methods of the invention are primarily directed to the detection and identification of the above polymorphisms associated with ACS. These polymorphisms are typically single nucleotide polymorphisms. In general terms, a single nucleotide polymorphism (SNP) is a single base change or point mutation resulting in genetic variation between individuals. SNPs occur in the human genome approximately once every 100 to 300 bases, and can occur in coding or non-coding regions. Due to the redundancy of the genetic code, a SNP in the coding region may or may not change the amino acid sequence of a protein product. A SNP in a non-coding region can, for example, alter gene expression by, for example, modifying control regions such as promoters, transcription factor binding sites, processing sites, ribosomal binding sites, and affect gene transcription, processing, and translation.

SNPs can facilitate large-scale association genetics studies, and there has recently been great interest in SNP discovery and detection. SNPs show great promise as markers for a number of phenotypic traits (including latent traits), such as for example, disease propensity and severity, wellness propensity, and drug responsiveness including, for example, susceptibility to adverse drug reactions. Knowledge of the association of a particular SNP with a phenotypic trait, coupled with the knowledge of whether an individual has said particular SNP, can enable the targeting of diagnostic, preventative and therapeutic applications to allow better disease management, to enhance understanding of disease states and to ultimately facilitate the discovery of more effective treatments, such as personalised treatment regimens.

Indeed, a number of databases have been constructed of known SNPs, and for some such SNPs, the biological effect associated with a SNP. For example, the NCBI SNP database “dbSNP” is incorporated into NCBI's Entrez system and can be queried using the same approach as the other Entrez databases such as PubMed and GenBank. This database has records for over 1.5 million SNPs mapped onto the human genome sequence. Each dbSNP entry includes the sequence context of the polymorphism (i.e., the surrounding sequence), the occurrence frequency of the polymorphism (by population or individual), and the experimental method(s), protocols, and conditions used to assay the variation, and can include information associating a SNP with a particular phenotypic trait.

At least in part because of the potential impact on health and wellness, there has been and continues to be a great deal of effort to develop methods that reliably and rapidly identify SNPs. This is no trivial task, at least in part because of the complexity of human genomic DNA, with a haploid genome of 3×10⁹ base pairs, and the associated sensitivity and discriminatory requirements.

Genotyping approaches to detect SNPs well-known in the art include DNA sequencing, methods that require allele specific hybridization of primers or probes, allele specific incorporation of nucleotides to primers bound close to or adjacent to the polymorphisms (often referred to as “single base extension”, or “minisequencing”), allele-specific ligation (joining) of oligonucleotides (ligation chain reaction or ligation padlock probes), allele-specific cleavage of oligonucleotides or PCR products by restriction enzymes (restriction fragment length polymorphisms analysis or RFLP) or chemical or other agents, resolution of allele-dependent differences in electrophoretic or chromatographic mobilities, by structure specific enzymes including invasive structure specific enzymes, or mass spectrometry. Analysis of amino acid variation is also possible where the SNP lies in a coding region and results in an amino acid change.

DNA sequencing allows the direct determination and identification of SNPs. The benefits in specificity and accuracy are generally outweighed for screening purposes by the difficulties inherent in whole genome, or even targeted subgenome, sequencing.

Mini-sequencing involves allowing a primer to hybridize to the DNA sequence adjacent to the SNP site on the test sample under investigation. The primer is extended by one nucleotide using all four differentially tagged fluorescent dideoxynucleotides (A, C, G, or T), and a DNA polymerase. Only one of the four nucleotides (homozygous case) or two of the four nucleotides (heterozygous case) is incorporated. The base that is incorporated is complementary to the nucleotide at the SNP position.

A number of methods currently used for SNP detection involve site-specific and/or allele-specific hybridisation. These methods are largely reliant on the discriminatory binding of oligonucleotides to target sequences containing the SNP of interest. The techniques of Affymetrix (Santa Clara, Calif.) and Nanogen Inc. (San Diego, Calif.) are particularly well-known, and utilize the fact that DNA duplexes containing single base mismatches are much less stable than duplexes that are perfectly base-paired. The presence of a matched duplex is detected by fluorescence.

The majority of methods to detect or identify SNPs by site-specific hybridisation require target amplification by methods such as PCR to increase sensitivity and specificity (see, for example U.S. Pat. No. 5,679,524, PCT publication WO 98/59066, PCT publication WO 95/12607). US Application 20050059030 (incorporated herein in its entirety) describes a method for detecting a single nucleotide polymorphism in total human DNA without prior amplification or complexity, reduction to selectively enrich for the target sequence, and without the aid of any enzymatic reaction. The method utilises a single-step hybridization involving two hybridization events: hybridization of a first portion of the target sequence to a capture probe, and hybridization of a second portion of said target sequence to a detection probe. Both hybridization events happen in the same reaction, and the order in which hybridisation occurs is not critical.

US Application 20050042608 (incorporated herein in its entirety) describes a modification of the method of electrochemical detection of nucleic acid hybridization of Thorp et al. (U.S. Pat. No. 5,871,918). Briefly, capture probes are designed, each of which has a different SNP base and a sequence of probe bases on each side of the SNP base. The probe bases are complementary to the corresponding target sequence adjacent to the SNP site. Each capture probe is immobilized on a different electrode having a non-conductive outer layer on a conductive working surface of a substrate. The extent of hybridization between each capture probe and the nucleic acid target is detected by detecting the oxidation-reduction reaction at each electrode, utilizing a transition metal complex. These differences in the oxidation rates at the different electrodes are used to determine whether the selected nucleic acid target has a single nucleotide polymorphism at the selected SNP site.

The technique of Lynx Therapeutics (Hayward, Calif.) using MEGATYPE™ technology can genotype very large numbers of SNPs simultaneously from small or large pools of genomic material. This technology uses fluorescently labeled probes and compares the collected genomes of two populations, enabling detection and recovery of DNA fragments spanning SNPs that distinguish the two populations, without requiring prior SNP mapping or knowledge.

A number of other methods for detecting and identifying SNPs exist. These include the use of mass spectrometry, for example, to measure probes that hybridize to the SNP. This technique varies in how rapidly it can be performed, from a few samples per day to a high throughput of 40,000 SNPs per day, using mass code tags. A preferred example is the use of mass spectrometric determination of a nucleic acid sequence which comprises the polymorphisms of the invention, for example, which includes the promoter of the COX2 gene or a complementary sequence. Such mass spectrometric methods are known to those skilled in the art, and the genotyping methods of the invention are amenable to adaptation for the mass spectrometric detection of the polymorphisms of the invention, for example, the COX2 promoter polymorphisms of the invention.

SNPs can also be determined by ligation-bit analysis. This analysis requires two primers that hybridize to a target with a one nucleotide gap between the primers. Each of the four nucleotides is added to a separate reaction mixture containing DNA polymerase, ligase, target DNA and the primers. The polymerase adds a nucleotide to the 3′ end of the first primer that is complementary to the SNP, and the ligase then ligates the two adjacent primers together. Upon heating of the sample, if ligation has occurred, the now larger primer will remain hybridized and a signal, for example, fluorescence, can be detected. A further discussion of these methods can be found in U.S. Pat. Nos. 5,919,626; 5,945,283; 5,242,794; and 5,952,174.

U.S. Pat. No. 6,821,733 (incorporated herein in its entirety) describes methods to detect differences in the sequence of two nucleic acid molecules that includes the steps of: contacting two nucleic acids under conditions that allow the formation of a four-way complex and branch migration; contacting the four-way complex with a tracer molecule and a detection molecule under conditions in which the detection molecule is capable of binding the tracer molecule or the four-way complex; and determining binding of the tracer molecule to the detection molecule before and after exposure to the four-way complex. Competition of the four-way complex with the tracer molecule for binding to the detection molecule indicates a difference between the two nucleic acids.

Protein- and proteomics-based approaches are also suitable for polymorphism detection and analysis. Polymorphisms which result in or are associated with variation in expressed proteins can be detected directly by analysing said proteins. This typically requires separation of the various proteins within a sample, by, for example, gel electrophoresis or HPLC, and identification of said proteins or peptides derived therefrom, for example by NMR or protein sequencing such as chemical sequencing or more prevalently mass spectrometry. Proteomic methodologies are well known in the art, and have great potential for automation. For example, integrated systems, such as the ProteomIQ™ system from Proteome Systems, provide high throughput platforms for proteome analysis combining sample preparation, protein separation, image acquisition and analysis, protein processing, mass spectrometry and bioinformatics technologies.

The majority of proteomic methods of protein identification utilise mass spectrometry, including ion trap mass spectrometry, liquid chromatography (LC) and LC/MSn mass spectrometry, gas chromatography (GC) mass spectroscopy, Fourier transform-ion cyclotron resonance-mass spectrometer (FT-MS), MALDI-TOF mass spectrometry, and ESI mass spectrometry, and their derivatives. Mass spectrometric methods are also useful in the determination of post-translational modification of proteins, such as phosphorylation or glycosylation, and thus have utility in determining polymorphisms that result in or are associated with variation in post-translational modifications of proteins.

Associated technologies are also well known, and include, for example, protein processing devices such as the “Chemical Inkjet Printer” comprising piezoelectric printing technology that allows in situ enzymatic or chemical digestion of protein samples electroblotted from 2-D PAGE gels to membranes by jetting the enzyme or chemical directly onto the selected protein spots. After in-situ digestion and incubation of the proteins, the membrane can be placed directly into the mass spectrometer for peptide analysis.

A large number of methods reliant on the conformational variability of nucleic acids have been developed to detect SNPs.

For example, Single Strand Conformational Polymorphism (SSCP, Orita et al., PNAS 1989 86:2766-2770) is a method reliant on the ability of single-stranded nucleic acids to form secondary structure in solution under certain conditions. The secondary structure depends on the base composition and can be altered by a single nucleotide substitution, causing differences in electrophoretic mobility under nondenaturing conditions. The various polymorphs are typically detected by autoradiography when radioactively labelled, by silver staining of bands, by hybridisation with detectably labelled probe fragments or the use of fluorescent PCR primers which are subsequently detected, for example by an automated DNA sequencer.

Modifications of SSCP are well known in the art, and include the use of differing gel running conditions, such as for example differing temperature, or the addition of additives, and different gel matrices. Other variations on SSCP are well known to the skilled artisan, including, RNA-SSCP, restriction endonuclease fingerprinting-SSCP, dideoxy fingerprinting (a hybrid between dideoxy sequencing and SSCP), bi-directional dideoxy fingerprinting (in which the dideoxy termination reaction is performed simultaneously with two opposing primers), and Fluorescent PCR-SSCP (in which PCR products are internally labelled with multiple fluorescent dyes, may be digested with restriction enzymes, followed by SSCP, and analysed on an automated DNA sequencer able to detect the fluorescent dyes).

Other methods which utilise the varying mobility of different nucleic acid structures include Denaturing Gradient Gel Electrophoresis (DGGE), Temperature Gradient Gel Electrophoresis (TGGE), and Heteroduplex Analysis (HET). Here, variation in the dissociation of double stranded DNA (for example, due to base-pair mismatches) results in a change in electrophoretic mobility. These mobility shifts are used to detect nucleotide variations.

Denaturing High Pressure Liquid Chromatography (HPLC) is yet a further method utilised to detect SNPs, using HPLC methods well-known in the art as an alternative to the separation methods described above (such as gel electophoresis) to detect, for example, homoduplexes and heteroduplexes which elute from the HPLC column at different rates, thereby enabling detection of mismatch nucleotides and thus SNPs.

Yet further methods to detect SNPs rely on the differing susceptibility of single stranded and double stranded nucleic acids to cleavage by various agents, including chemical cleavage agents and nucleolytic enzymes. For example, cleavage of mismatches within RNA:DNA heteroduplexes by RNase A, of heteroduplexes by, for example bacteriophage T4 endonuclease YII or T7 endonuclease I, of the 5′ end of the hairpin loops at the junction between single stranded and double stranded DNA by cleavase I, and the modification of mispaired nucleotides within heteroduplexes by chemical agents commonly used in Maxam-Gilbert sequencing chemistry, are all well known in the art.

Further examples include the Protein Translation Test (PTT), used to resolve stop codons generated by variations which lead to a premature termination of translation and to protein products of reduced size, and the use of mismatch binding proteins. Variations are detected by binding of, for example, the MutS protein, a component of Escherichia coli DNA mismatch repair system, or the human hMSH2 and GTBP proteins, to double stranded DNA heteroduplexes containing mismatched bases. DNA duplexes are then incubated with the mismatch binding protein, and variations are detected by mobility shift assay. For example, a simple assay is based on the fact that the binding of the mismatch binding protein to the heteroduplex protects the heteroduplex from exonuclease degradation.

Those skilled in the art will know that a particular SNP, particularly when it occurs in a regulatory region of a gene such as a promoter, can be associated with altered expression of a gene. Altered expression of a gene can also result when the SNP is located in the coding region of a protein-encoding gene, for example where the SNP is associated with codons of varying usage and thus with tRNAs of differing abundance. Such altered expression can be determined by methods well known in the art, and can thereby be employed to detect such SNPs. Similarly, where a SNP occurs in the coding region of a gene and results in a non-synonymous amino acid substitution, such substitution can result in a change in the function of the gene product. Similarly, in cases where the gene product is an RNA, such SNPs can result in a change of function in the RNA gene product. Any such change in function, for example as assessed in an activity or functionality assay, can be employed to detect such SNPs.

The above methods of detecting and identifying SNPs are amenable to use in the methods of the invention.

Of course, in order to detect and identify SNPs in accordance with the invention, a sample containing material to be tested is obtained from the subject. The sample can be any sample potentially containing the target SNPs (or target polypeptides, as the case may be) and obtained from any bodily fluid (blood, urine, saliva, etc) biopsies or other tissue preparations.

DNA or RNA can be isolated from the sample according to any of a number of methods well known in the art. For example, methods of purification of nucleic acids are described in Tijssen; Laboratory Techniques in Biochemistry and Molecular Biology: Hybridization with nucleic acid probes Part 1: Theory and Nucleic acid preparation, Elsevier, New York, N.Y. 1993, as well as in Maniatis, T., Fritsch, E. F. and Sambrook, J., Molecular Cloning Manual 1989.

To assist with detecting the presence or absence of polymorphisms/SNPs, nucleic acid probes and/or primers can be provided. Such probes have nucleic acid sequences specific for chromosomal changes evidencing the presence or absence of the polymorphism and are preferably labeled with a substance that emits a detectable signal when combined with the target polymorphism.

The nucleic acid probes can be genomic DNA or cDNA or mRNA, or any RNA-like or DNA-like material, such as peptide nucleic acids, branched DNAs, and the like. The probes can be sense or antisense polynucleotide probes. Where target polynucleotides are double-stranded, the probes may be either sense or antisense strands. Where the target polynucleotides are single-stranded, the probes are complementary single strands.

The probes can be prepared by a variety of synthetic or enzymatic schemes, which are well known in the art. The probes can be synthesized, in whole or in part, using chemical methods well known in the art (Caruthers et al., Nucleic Acids Res., Symp. Ser., 215-233 (1980)). Alternatively, the probes can be generated, in whole or in part, enzymatically.

Nucleotide analogs can be incorporated into probes by methods well known in the art. The only requirement is that the incorporated nucleotide analog must serve to base pair with target polynucleotide sequences. For example, certain guanine nucleotides can be substituted with hypoxanthine, which base pairs with cytosine residues. However, these base pairs are less stable than those between guanine and cytosine. Alternatively, adenine nucleotides can be substituted with 2,6-diaminopurine, which can form stronger base pairs than those between adenine and thymidine.

Additionally, the probes can include nucleotides that have been derivatized chemically or enzymatically. Typical chemical modifications include derivatization with acyl, alkyl, aryl or amino groups.

The probes can be immobilized on a substrate. Preferred substrates are any suitable rigid or semi-rigid support including membranes, filters, chips, slides, wafers, fibers, magnetic or nonmagnetic beads, gels, tubing, plates, polymers, microparticles and capillaries. The substrate can have a variety of surface forms, such as wells, trenches, pins, channels and pores, to which the polynucleotide probes are bound. Preferably, the substrates are optically transparent.

Furthermore, the probes do not have to be directly bound to the substrate, but rather can be bound to the substrate through a linker group. The linker groups are typically about 6 to 50 atoms long to provide exposure to the attached probe. Preferred linker groups include ethylene glycol oligomers, diamines, diacids and the like. Reactive groups on the substrate surface react with one of the terminal portions of the linker to bind the linker to the substrate. The other terminal portion of the linker is then functionalized for binding the probe.

The probes can be attached to a substrate by dispensing reagents for probe synthesis on the substrate surface or by dispensing preformed DNA fragments or clones on the substrate surface. Typical dispensers include a micropipette delivering solution to the substrate with a robotic system to control the position of the micropipette with respect to the substrate. There can be a multiplicity of dispensers so that reagents can be delivered to the reaction regions simultaneously.

Nucleic acid microarrays are preferred. Such microarrays (including nucleic acid chips) are well known in the art (see, for example U.S. Pat. Nos. 5,578,832; 5,861,242; 6,183,698; 6,287,850; 6,291,183; 6,297,018; 6,306,643; and 6,308,170, each incorporated by reference).

Alternatively, antibody microarrays can be produced. The production of such microarrays is essentially as described in Schweitzer & Kingsmore, “Measuring proteins on microarrays”, Curr Opin Biotechnol 2002; 13(1): 14-9; Avseekno et al., “Immobilization of proteins in immunochemical microarrays fabricated by electrospray deposition”, Anal Chem 2001 15; 73(24): 6047-52; Huang, “Detection of multiple proteins in an antibody-based protein microarray system, Immunol Methods 2001 1; 255 (1-2): 1-13.

The present invention also contemplates the preparation of kits for use in accordance with the present invention. Suitable kits include various reagents for use in accordance with the present invention in suitable containers and packaging materials, including tubes, vials, and shrink-wrapped and blow-molded packages.

Materials suitable for inclusion in an exemplary kit in accordance with the present invention comprise one or more of the following: gene specific PCR primer pairs (oligonucleotides) that anneal to DNA or cDNA sequence domains that flank the genetic polymorphisms of interest, reagents capable of amplifying a specific sequence domain in either genomic DNA or cDNA without the requirement of performing PCR; reagents required to discriminate between the various possible alleles in the sequence domains amplified by PCR or non-PCR amplification (e.g., restriction endonucleases, oligonucleotide that anneal preferentially to one allele of the polymorphism, including those modified to contain enzymes or fluorescent chemical groups that amplify the signal from the oligonucleotide and make discrimination of alleles more robust); reagents required to physically separate products derived from the various alleles (e.g. agarose or polyacrylamide and a buffer to be used in electrophoresis, HPLC columns, SSCP gels, formamide gels or a matrix support for MALDI-TOF).

It will be appreciated that the methods of the invention can be performed in conjunction with an analysis of other risk factors known to be associated with ACS. Such risk factors include epidemiological risk factors associated with an increased risk of developing ACS. Such risk factors include, but are not limited to smoking and/or exposure to tobacco smoke, age, sex and familial history. These risk factors can be used to augment an analysis of one or more polymorphisms as herein described when assessing a subject's risk of developing ACS.

The predictive methods of the invention allow a number of therapeutic interventions and/or treatment regimens to be assessed for suitability and implemented for a given subject. The simplest of these can be the provision to the subject of motivation to implement a lifestyle change, for example, where the subject is a current smoker, the methods of the invention can provide motivation to quit smoking.

The manner of therapeutic intervention or treatment will be predicated by the nature of the polymorphism(s) and the biological effect of said polymorphism(s). For example, where a susceptibility polymorphism is associated with a change in the expression of a gene, intervention or treatment is preferably directed to the restoration of normal expression of said gene, by, for example, administration of an agent capable of modulating the expression of said gene. Where a polymorphism is associated with decreased expression of a gene, therapy can involve administration of an agent capable of increasing the expression of said gene, and conversely, where a polymorphism is associated with increased expression of a gene, therapy can involve administration of an agent capable of decreasing the expression of said gene. Methods useful for the modulation of gene expression are well known in the art. For example, in situations where a polymorphism is associated with upregulated expression of a gene, therapy utilising, for example, RNAi or antisense methodologies can be implemented to decrease the abundance of mRNA and so decrease the expression of said gene. Alternatively, therapy can involve methods directed to, for example, modulating the activity of the product of said gene, thereby compensating for the abnormal expression of said gene.

Where a susceptibility polymorphism is associated with decreased gene product function or decreased levels of expression of a gene product, therapeutic intervention or treatment can involve augmenting or replacing of said function, or supplementing the amount of gene product within the subject for example, by administration of said gene product or a functional analogue thereof. For example, where a polymorphism is associated with decreased enzyme function, therapy can involve administration of active enzyme or an enzyme analogue to the subject. Similarly, where a polymorphism is associated with increased gene product function, therapeutic intervention or treatment can involve reduction of said function, for example, by administration of an inhibitor of said gene product or an agent capable of decreasing the level of said gene product in the subject. For example, where a SNP allele or genotype is associated with increased enzyme function, therapy can involve administration of an enzyme inhibitor to the subject.

Likewise, when a protective polymorphism is associated with upregulation of a particular gene or expression of an enzyme or other protein, therapies can be directed to mimic such upregulation or expression in an individual lacking the resistive genotype, and/or delivery of such enzyme or other protein to such individual Further, when a protective polymorphism is associated with downregulation of a particular gene, or with diminished or eliminated expression of an enzyme or other protein, desirable therapies can be directed to mimicking such conditions in an individual that lacks the protective genotype.

The relationship between the various polymorphisms identified above and the susceptibility (or otherwise) of a subject to ACS also has application in the design and/or screening of candidate therapeutics. This is particularly the case where the association between a polymorphism predictive of susceptibility is manifested by either an upregulation or downregulation of expression of a gene. In such instances, the effect of a candidate therapeutic on such upregulation or downregulation is readily detectable.

For example, in one embodiment existing human vascular organ and cell cultures are screened for SNP genotypes as set forth above. (For information on human vascular organ and cell cultures, see for example: Clare Wise ED., Epithelial Cell Culture Protocols, 2002, ISBN 0896038939, Humana Press Inc. NJ; Endothelial Cell Culture, Roy Bicknell, ED., 1996, ISBN 0521550246, Cambridge University Press, UK; Cell Culture Models of Biological Barriers, Claus-Michael Lehr, ED., 2002, ISBN 0415277248, Taylor and Francis, UK; each of which is hereby incorporated by reference in its entirety.) Cultures representing relevant genotype groups are selected, together with cultures which are putatively “normal” in terms of the expression of a gene which is either upregulated or downregulated where a polymorphism is present.

Samples of such cultures are exposed to a library of candidate therapeutic compounds and screened for: (a) downregulation of genes that are normally upregulated in susceptible genotypes; or (b) upregulation of genes that are normally downregulated in susceptible genotypes. Compounds are selected for their ability to alter the regulation and/or action of genes in a culture having a susceptible genotype.

Similarly, where the polymorphism is one which when present results in a physiologically active concentration of an expressed gene product outside of the normal range for a subject (adjusted for age and sex), and where there is an available prophylactic or therapeutic approach to restoring levels of that expressed gene product to within the normal range, individual subjects can be screened to determine the likelihood of their benefiting from that restorative approach. Such screening involves detecting the presence or absence of the polymorphism in the subject by any of the methods described herein, with those subjects in which the polymorphism is present being identified as individuals likely to benefit from treatment.

The invention will now be described in more detail, with reference to the following non-limiting examples.

Example 1 Case Association Study Introduction

Case-control association studies allow the careful selection of a control group where matching for important risk factors is critical. In this study, smokers diagnosed with ACS and smokers without ACS were compared. This unique control group is highly relevant as it is impossible to pre-select smokers with zero risk of ACS—i.e., those who although smokers will never develop ACS. Smokers with a high pack year history and normal cardiovascular function were used as a “low risk” group of smokers, as the Applicants believe it is not possible with current knowledge to identify a lower risk group of smokers. The Applicants believe, without wishing to be bound by any theory, that this approach allows for a more rigorous comparison of low penetrant, high frequency polymorphisms that may confer an increased risk of developing ACS. The Applicants also believe, again without wishing to be bound by any theory, that there may be polymorphisms that confer a degree of protection from ACS which may only be evident if a smoking cohort with normal cardiovascular function is utilised as a comparator group. Thus, smokers with ACS would be expected to have a lower frequency of these polymorphisms compared to smokers with normal cardiovascular function and no diagnosed ACS.

Subjects of European decent who had smoked a minimum of fifteen pack years and diagnosed with acute coronary syndrome (ACS, including acute myocardial infarction and unstable angina) were recruited. Subjects met the following criteria: diagnosed with ACS based on clinical presentation (history, ECG, cardiac biomarker assays) to a tertiary care hospital. Subjects with ACS had had coronary angiograms that confirmed the presence of atheromatous disease of the coronary arteries. Subjects with ACS were aged between 40-60 yrs old and of European descent. One hundred and forty-eight subjects were recruited, of these 85% were male, the mean FEV1/FVC (±1 SD) was 74% (±8), mean FEV1 as a percentage of predicted was 94 (±15). Mean age, cigarettes per day and pack year history was 50 yrs (±3), 22 cigarettes/day (±8) and 31 pack years (±11), respectively. Four hundred and sixty European subjects who had smoked a minimum of fifteen pack years and who had never suffered from angina, chest pain, suffered a heart attack, or had been diagnosed with ischaemic heart disease in the past were also studied. This control group was recruited through community based volunteers who were ex-smokers or current smokers, and consisted 55% male, with a mean FEV1/FVC (±1 SD) of 75% (±9), and mean FEV1 as a percentage of predicted was 98 (±12). Mean age, cigarettes per day and pack year history was 60 yrs (±10), 23 cigarettes/day (±11) and 40 pack years (±21), respectively.

This study shows that polymorphisms found in greater frequency in acute coronary syndrome patients compared to resistant smokers may reflect an increased susceptibility to the development of life-threatening acute coronary syndrome. Similarly, polymorphisms found in greater frequency in resistant smokers compared to acute coronary syndrome patients may reflect a protective role.

Summary of Characteristics for the Acs Cohort and Resistant Control Smokers.

Acute Coronary Resistant Parameter syndrome smokers Mean (1SD) N = 148 N = 460 Differences % male 85% 55% P < 0.05 Age (yrs) 50 (3) 60 (10) P < 0.05 Pack years 31 (11) 40 (21) P < 0.05 Cigarettes/day 22 (8) 23 (11) ns FEV1 (L) 3.3 (0.7) 2.7 (0.6) P < 0.05 FEV1 % predict 94 (15) 98% (12) P < 0.05 FEV1/FVC 74 (8) 75 (9) P < 0.05 Means and 1SD

Genotyping Methods Polymorphism Genotyping Using the Sequenom Autoflex Mass Spectrometer

Genomic DNA was extracted from whole blood samples (Maniatis, T., Fritsch, E. F. and Sambrook, J., Molecular Cloning Manual. 1989). Purified genomic DNA was aliquoted (10 ng/ul concentration) into 96 well plates and genotyped on a Sequenom™ system (Sequenom™ Autoflex Mass Spectrometer and Samsung 24 pin nanodispenser) using the following sequences, amplification conditions and methods.

The following conditions were used for the PCR multiplex reaction: final concentrations were for 10×Buffer 15 mM MgCl₂ 1.25×, 25 mM MgCl₂ 1.625 mM, dNTP mix 25 mM 500 uM, primers 4 uM 100 nM, Taq polymerase (Quiagen hot start) 0.15 U/reaction, Genomic DNA 10 ng/ul. Cycling times were 95° C. for 15 min, (5° C. for 15 s, 56° C. 30 s, 72° C. 30 s for 45 cycles with a prolonged extension time of 3 min to finish. We used shrimp alkaline phosphatase (SAP) treatment (2 ul to 5 ul per PCR reaction) incubated at 35° C. for 30 min and extension reaction (add 2 ul to 7 ul after SAP treatment) with the following volumes per reaction of: water, 0.76 ul; hME 10× termination buffer, 0.2 ul; hME primer (10 uM), 1 ul; Mass EXTEND enzyme, 0.04 ul. See Tables 1-26 for full name of SNPs and candidate genes.

Sequenom conditions for PCR and Mass spectrometer genotyping SNP_ID SNP Name 2nd-PCRP 1st-PCRP PDGFA PDGFA 12 IN5 C/T ACGTTGGATGAAGGCTCTGAAGACCTGTTC ACGTTGGATGATCCGGATTATCGGGAAGAG [SEQ.ID.NO. 1] [SEQ.ID.NO. 2] RS17580 1-antitrypsin S allele ACGTTGGATGCTTGGTGATGATATCGTGGG ACGTTGGATGTCTTCTTCCTGCCTGATGAG [SEQ.ID.NO. 3] [SEQ.ID.NO. 4] RS1799983 NOS3 298 G/T ACGTTGGATGAAACGGTCGCTTCGACGTG ACGTTGGATGGGGCAGAAGGAAGAGTTC [SEQ.ID.NO. 5] [SEQ.ID.NO. 6] RS1800469 TGFB1 −509 C/T ACGTTGGATGTACAGGTGTCTGCCTCCTGA ACGTTGGATGAAGAGGGTCTGTCAACATGG [SEQ.ID.NO. 7] [SEQ.ID.NO. 8] RS1151640 OG13G1 132 A/G ACGTTGGATGATAGCCATGACCATGCTGAG ACGTTGGATGGGCCATTTGTTTCCCTCTTC [SEQ.ID.NO. 9] [SEQ.ID.NO. 10] RS2276109 MMP12 −82 A/G ACGTTGGATGTTGAGATAGATCAAGGGATG ACGTTGGATGGTCCGGGTTCTGTGAATATG [SEQ.ID.NO. 11] [SEQ.ID.NO. 12] RS4986790 TLR4 299 A/G ACGTTGGATGAGCATACTTAGACTACTACC ACGTTGGATGCACACTCACCAGGGAAAATG [SEQ.ID.NO. 13] [SEQ.ID.NO. 14] RS1800896 IL-10 −1084 A/G ACGTTGGATGATTCCATGGAGGCTGGATAG ACGTTGGATGGACAACACTACTAAGGCTTC [SEQ.ID.NO. 15] [SEQ.ID.NO. 16] RS5498 ICAM1 K469E A/G ACGTTGGATGACTCACAGAGCACATTCACG ACGTTGGATGTGTCACTCGAGATCTTGAGG [SEQ.ID.NO. 17] [SEQ.ID.NO. 18] RS1449683 FGF2 Ser52Ser C/T ACGTTGGATGAGGCGGCGTCCGCGGAGACA ACGTTGGATGCTCGGCCGCTCTTCTGTCC [SEQ.ID.NO. 19] [SEQ.ID.NO. 20] RS2239527 BAT1 −23 C/G ACGTTGGATGTTACCTAAACAGGGAGAGCG ACGTTGGATGAAGCCTGCAACCGGAAGTG [SEQ.ID.NO. 21] [SEQ.ID.NO. 22] RS1799895 SOD3 Arg213Gly C/G ACGTTGGATGCTCAGGCGGCCTTGCACTC ACGTTGGATGAGGCGCGGGAGCACTCAGA [SEQ.ID.NO. 23] [SEQ.ID.NO. 24] RS1800875 CMA1 −1903 A/G ACGTTGGATGGCTCCACAGCATCAAGATTC ACGTTGGATGTTCCATTTCCTCACCCTCAG [SEQ.ID.NO. 25] [SEQ.ID.NO. 26] RS1719134 MIP1A +459 C/T ACGTTGGATGGGTTCAAGAAGTCATACCCC ACGTTGGATGAGCTCTGTCCCTTGGATGTC [SEQ.ID.NO. 27] [SEQ.ID.NO. 28] RS2243250 IL-4 −589 C/T ACGTTGGATGCGACCTGTCCTTCTCAAAAC ACGTTGGATGGAATAACAGGCAGACTCTCC [SEQ.ID.NO. 29] [SEQ.ID.NO. 30] RS1801275 IL-4RA Q576R A/G ACGTTGGATGGAAATGTCCTCCAGCATGGG ACGTTGGATGACCCTGCTCCACCGCATGTA [SEQ.ID.NO. 31] [SEQ.ID.NO. 32] RS2227956 HASP70 Horn T2437C ACGTTGGATGTGATCTTGTTCACCTTGCCG ACGTTGGATGCGAGGTGACGTTTGACATTG [SEQ.ID.NO. 33] [SEQ.ID.NO. 34] RS1799750 MMP1 −1607 1G/2G ACGTTGGATGCTTCAGTATATCTTGGATTG ACGTTGGATGGTTATGCCACTTAGATGAGG [SEQ.ID.NO. 35] [SEQ.ID.NO. 36] RS17880821 MMP7 −181 A/G ACGTTGGATGGGAGTCAATTTATGCAGCAG ACGTTGGATGCATCGTTATTGGCAGGAAGC [SEQ.ID.NO. 37] [SEQ.ID.NO. 38] RS4986791 TLR4 399 C/T ACGTTGGATGAGCCCAAGAAGTTTGAACTC ACGTTGGATGAGGTTGCTGTTCTCAAAGTG [SEQ.ID.NO. 39] [SEQ.ID.NO. 40] RS1041981 LTA Thr26Asn A/C ACGTTGGATGGAGGTCAGGTGGATGTTTAC ACGTTGGATGACCCCAAGATGCATCTTGCC [SEQ.ID.NO. 41] [SEQ.ID.NO. 42] PDGFRA PDGFRA −1630 I/D ACGTTGGATGGGCAACTAGCCTAAAAACCC ACGTTGGATGCAGAGTGCGGAATAAAAGGC [SEQ.ID.NO. 43] [SEQ.ID.NO. 44] GCLM GCLM −588 C/T ACGTTGGATGTGAGGTAGACACCGCCTCC ACGTTGGATGAAGAGACGTGTAGGAAGCCC [SEQ.ID.NO. 45] [SEQ.ID.NO. 46] RS2430561 IGN-G 874 A/T ACGTTGGATGCAGACATTCACAATTGATT ACGTTGGATGGATAGTTCCAAACATGTGCG [SEQ.ID.NO. 47] [SEQ.ID.NO. 48] RS2071592 NFKBIL1 −63 T/A ACGTTGGATGTAACGCCCCTCACAGTTCAC ACGTTGGATGACTCCAGGCTGGAGGAAATG [SEQ.ID.NO. 49] [SEQ.ID.NO. 50] PAI1 PAI-1 −668 4G/5G ACGTTGGATGCACAGAGAGAGTCTGGACAC ACGTTGGATGTCTTGGTCTTTCCCTCATCC [SEQ.ID.NO. 51] [SEQ.ID.NO. 52] rs2066845 Caspase ACGTTGGATGGTCTGTTGACTCTTTTGGC ACGTTGGATGTGGTGATCACCCAAGGCTTC [SEQ.ID.NO. 105] [SEQ.ID.NO. 106] rs3732379 CX3CR1 ACGTTGGATGCATAGAGCTTAAGCGTCTCC ACGTTGGATGTGATCCTTCTGGTGGTCATC [SEQ.ID.NO. 107] [SEQ.ID.NO. 108] Cathespin G Cathepsin G Asn125Ser ACGTTGGATGTCAGTCCCTCCTGGGCTCTA ACGTTGGATGAGAAGAGTCAGACGGAATCG [SEQ.ID.NO. 109] [SEQ.ID.NO. 110] rs6520277 TIMP1 ACGTTGGATGGACTCTTGCACATCACTACC ACGTTGGATGAGTGTAGGTCTTGGTGAAGC [SEQ.ID.NO. 111] [SEQ.ID.NO. 112]

Sequenom conditions for PCR and Mass spectrometer genotyping SNP_ID SNP Name AMP_LEN UP_CONF MP_CONF Tm(NN) PcGC PWARN UEP_DIR UEP_MASS PDGFA PDGFA 12 IN5 C/T 100 100 65.1 50.4 62.5 R 5204.4 RS17580 1-antitrypsin S allele 91 99.7 65.1 47.3 47.1 R 5905.8 RS1799983 NOS3 298 G/T 93 87.8 65.1 59.9 63.2 sDh F 6143 RS1800469 TGFB1 −509 C/T 120 94.5 65.1 57.5 65 F 6543.2 RS1151640 OG13G1 132 A/G 101 100 65.1 48.4 38.1 d R 6718.4 RS2276109 MMP12 −82 A/G 88 93.8 65.1 48.9 34.8 D F 7095.6 RS4986790 TLR4 299 A/G 105 94.3 65.1 49.6 41.7 D F 7271.8 RS1800896 IL-10 −1084 A/G 107 98.4 65.1 57.6 50 D R 8272.4 RS5498 ICAM1 K469E A/G 115 99.1 70.7 47.9 50 d R 4801.1 RS1449683 FGF2 Ser52Ser C/T 115 55.7 70.7 52.6 68.8 d F 4836.2 RS2239527 BAT1 −23 C/G 102 95.9 70.7 48.9 52.9 R 5317.5 RS1799895 SOD3 Arg213Gly C/G 83 66.2 70.7 61.6 82.4 sD R 5652.7 RS1800875 CMA1 −1903 A/G 98 100 70.7 45.9 36.8 d R 5777.8 RS1719134 MIP1A +459 C/T 92 98.3 70.7 50.9 52.9 D R 5784.8 RS2243250 IL-4 −589 C/T 100 100 70.7 47.6 36.8 dH F 6205.1 RS1801275 IL-4RA Q576R A/G 109 90.4 70.7 55 66.7 d F 6886.5 RS2227956 HASP70 Hom T2437C 103 100 70.7 56.4 63.2 D R 6966.5 RS1799750 MMP1 −1607 1G/2G 104 86.4 70.7 45.4 29.2 H R 7405.8 RS17880821 MMP7 −181 A/G 99 98.6 70.7 48.4 28 d F 7684.1 RS4986791 TLR4 399 C/T 118 95.9 70.7 46.2 36.4 D R 8025.2 RS1041981 LTA Thr26Asn A/C 94 98.4 71.3 50.6 58.8 d R 5315.5 PDGFRA PDGFRA −1630 I/D 100 100 71.3 48.2 42.1 F 5740.8 GCLM GCLM −588 C/T 116 88.4 71.3 61.5 71.4 D R 6350.1 RS2430561 IGN-G 874 A/T 112 75.9 71.3 46.4 26.1 F 6943.6 RS2071592 NFKBIL1 −63 T/A 91 96.8 94.1 50.8 62.5 d R 4713.1 PAI1 PAI-1 −668 4G/5G 108 98.3 94.1 54.1 64.7 g F 5291.4 rs2066845 Caspase 113 95.8 61.5 50.5 47.4 D rs3732379 CX3CR1 104 99.9 61.5 52.8 39.1 Cathespin G Cathepsin G Asn125Ser 84 88.6 61.5 56.4 63.2 D rs6520277 TIMP1 109 99.7 61.5 47.2 44.4 d

Sequenom conditions for PCR and Mass spectrometer genotyping EXT1_(—) EXT1_(—) SNP_ID SNP Name UEP_SEQ CALL MASS EXT1_SEQ PDGFA PDGFA 12 IN5 tCACGATGCCGACGAAG T 5475.6 tCACGATGCCGACGAAGA C/T [SEQ.ID.NO. 53] [SEQ.ID.NO. 54] RS17580 1-antitrypsin S ggCGTGGGTGAGTTCATTT T 6177 ggCGTGGGTGAGTTCATTTA allele [SEQ.ID.NO. 55] [SEQ.ID.NO. 56] RS1799983 NOS3 298 G/T gTGCTGCAGGCCCCAGATGA G 6430.2 gTGCTGCAGGCCCCAGATGAG [SEQ.ID.NO. 57] [SEQ.ID.NO. 58] RS1800469 TGFB1 −509 cgGCCTCCTGACCCTTCCATCC C 6790.4 cgGCCTCCTGACCCTTCCATCCC C/T [SEQ.ID.NO. 59] [SEQ.ID.NO. 60] RS1151640 OG13G1 132 cCACACATATGGTGGTTCATAA G 6965.6 cCACACATATGGTGGTTCATAAC A/G [SEQ.ID.NO. 61] [SEQ.ID.NO. 62] RS2276109 MMP12 −82 TAGATCAAGGGATGATATCAACT A 7366.9 TAGATCAAGGGATGATATCAACTA A/G [SEQ.ID.NO. 63] [SEQ.ID.NO. 64] RS4986790 TLR4 299 A/G CATACTTAGACTACTACCTCGATG A 7543 CATACTTAGACTACTACCTCGATGA [SEQ.ID.NO. 65] [SEQ.ID.NO. 66] RS1800896 IL-10 −1084 CTTTCCTCTTACCTATCCCTACTTCCCC G 8519.6 CTTTCCTCTTACCTATCCCTACTTCCCCC A/G [SEQ.ID.NO. 67] [SEQ.ID.NO. 68] RS5498 ICAM1 K469E ACATTCACGGTCACCT G 5048.3 ACATTCACGGTCACCTC A/G [SEQ.ID.NO. 69] [SEQ.ID.NO. 70] RS1449683 FGF2 CGCGGAGACACCCATC C 5083.3 CGCGGAGACACCCATCC Ser52Ser C/T [SEQ.ID.NO. 71] [SEQ.ID.NO. 72] RS2239527 BAT1 −23 C/G CGACGAAGGAGGGAAAT G 5564.7 CGACGAAGGAGGGAAATC [SEQ.ID.NO. 73] [SEQ.ID.NO. 74] RS1799895 SOD3 tcCTCGCTCTCGCGCCGCC G 5899.8 tcCTCGCTCTCGCGCCGCCC Arg213Gly C/G [SEQ.ID.NO. 75] [SEQ.ID.NO. 76] RS1800875 CMA1 −1903 CCAAGACTTAAGTTTTGCT G 6025 CCAAGACTTAAGTTTTGCTC A/G [SEQ.ID.NO. 77] [SEQ.ID.NO. 78] RS1719134 MIP1A +459 ggACCCCAACCCAAGAGAA T 6056 ggACCCCAACCCAAGAGAAA C/T [SEQ.ID.NO. 79] [SEQ.ID.NO. 80] RS2243250 IL-4 −589 C/T gAAACTTGGGAGAACATTGT C 6452.2 gAAACTTGGGAGAACATTGTC [SEQ.ID.NO. 81] [SEQ.ID.NO. 82] RS1801275 IL-4RA Q576R ttcttCCCCCACCAGTGGCTATC A 7157.7 ttcttCCCCCACCAGTGGCTATCA A/G [SEQ.ID.NO. 83] [SEQ.ID.NO. 84] RS2227956 HASP70 Horn acaaCTTGCCGGTGCTCTTGTCC T 7237.7 acaaCTTGCCGGTGCTCTTGTCCA T2437C [SEQ.ID.NO. 85] [SEQ.ID.NO. 86] RS1799750 MMP1 −1607 GATTGATTTGAGATAAGTCATATC G 7653 GATTGATTTGAGATAAGTCATATCC 1G/2G [SEQ.ID.NO. 87] [SEQ.ID.NO. 88] RS17880821 MMP7 −181 CAGAAAAAAAAATCCTTTGAAAGAC A 7955.3 CAGAAAAAAAAATCCTTTGAAAGACA A/G [SEQ.ID.NO. 89] [SEQ.ID.NO. 90] RS4986791 TLR4 399 C/T ggtgCAGATCTAAATACTTTAGGCTG T 8296.4 ggtgCAGATCTAAATACTTTAGGCTGA [SEQ.ID.NO. 91] [SEQ.ID.NO. 92] RS1041981 LTA Thr26Asn GAGCAGCAGGTTTGAGG C 5602.7 GAGCAGCAGGTTTGAGGG A/C [SEQ.ID.NO. 93] [SEQ.ID.NO. 94] PDGFRA PDGFRA −1630 TAAAAACCCGGTTCTCAAC DEL 6012 TAAAAACCCGGTTCTCAACA I/D [SEQ.ID.NO. 95] [SEQ.ID.NO. 96] GCLM GCLM −588 CTCCGCCTGGTGAGGTCTCCC T 6621.3 CTCCGCCTGGTGAGGTCTCCCA C/T [SEQ.ID.NO. 97] [SEQ.ID.NO. 98] RS2430561 IGN-G 874 A/T TTCTTACAACACAAAATCAAATC A 7214.8 TTCTTACAACACAAAATCAAATCA [SEQ.ID.NO. 99] [SEQ.ID.NO. 100] RS2071592 NFKBIL1 −63 ACTTCCGTCCTCCACC T 4984.3 ACTTCCGTCCTCCACCA T/A [SEQ.ID.NO. 101] [SEQ.ID.NO. 102] PAI1 PAI-1 −668 AGTCTGGACACGTGGGG DEL 5562.6 AGTCTGGACACGTGGGGA 4G/5G [SEQ.ID.NO. 103] [SEQ.ID.NO. 104]

Sequenom conditions for PCR and Mass spectrometer genotyping UEP_(—) UEP_(—) EXT1_(—) EXT1_(—) SNP_ID SNP DIR MASS UEP_SEQ CALL MASS EXT1_SEQ rs2066845 Caspase F 5800.8 TGGCCTTTTCAGATTCTGG C 6048 TGGCCTTTTCAGATTCTGGC [SEQ.ID.NO. 113] [SEQ.ID.NO. 114] rs3732379 CX3CR1 F 7049.6 AAGCGTCTCCAGGAAAATCATAA C 7296.8 AAGCGTCTCCAGGAAAATCATAAC [SEQ.ID.NO. 115] [SEQ.ID.NO. 116] Cathespin G Cathepsin G R 7458.8 tgggaTCTAGGCAGAGCCACTGGG G 7706 tgggaTCTAGGCAGAGCCACTGGGC Asn125Ser [SEQ.ID.NO. 117] [SEQ.ID.NO. 118] rs6520277 TIMP1 F 5987.9 ccCATCACTACCTGCAGTTT C 6235.1 ccCATCACTACCTGCAGTTTC [SEQ.ID.NO. 119] [SEQ.ID.NO. 120]

Sequenom conditions for PCR and Mass spectrometer genotyping SNP_ID SNP EXT2_CALL EXT2_MASS EXT2_SEQ rs2066845 Caspase G 6088 TGGCCTTTTCAGATTCTGGG [SEQ.ID.NO. 121] rs3732379 CX3CR1 T 7376.7 AAGCGTCTCCAGGAAAATCATAAT [SEQ.ID.NO. 122] Asn125Ser Cathepsin G A 7785.9 tgggaTCTAGGCAGAGCCACTGGGT [SEQ.ID.NO. 123] rs6520277 TIMP1 T 6315 ccCATCACTACCTGCAGTTTT [SEQ.ID.NO. 124]

Results

TABLE 1 Chymase 1 (CMA) −1903 A/G polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A G AA AG GG ACS 135 (48%) 149 (52%)  38 (27%)  59 (42%) 45 (32%) n = 142 (%) Resistant 508 (56%) 396 (44%) 145 (32%) 218 (48%) 89 (20%) n = 452 (%) *number of chromosomes (2n) Genotype. GG vs AG/AA for ACS vs resistant smoker controls, Odds ratio (OR)=1.9, 95% confidence limits 1.2-3.0, χ² (Mantel-Haenszel)=8.23, p=0.004,

GG genotype=susceptibility

Allele G vs A, ACS vs resistant smoker controls, Odds ratio (OR)=1.4, 95% confidence limits 1.1-1.9, χ² (Mantel-Haenszel)=6.52, p=0.01,

G allele=susceptibility

TABLE 2 Transforming growth factor beta 1 (TGFB1) −509 C/T polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency C T CC CT TT ACS 222 (76%)  72 (24%)  84 (57%)  54 (37%)  9 (6%) n = 147 (%) Resistant 636 (70%) 278 (30%) 216 (47%) 204 (45%) 37 (8%) n = 457 (%) *number of chromosomes (2n) Genotype. CC vs CT/TT for ACS vs resistant smoker controls, Odds ratio (OR)=1.5, 95% confidence limits 1.0-2.2, χ² (Mantel-Haenszel) 3.96, p=0.05,

CC genotype=susceptibility

Allele. C vs T for ACS vs resistant smoker controls, Odds ratio (OR)=1.4, 95% confidence limits 1.0-1.8, χ² (Mantel-Haenszel)=3.79, p=0.05,

C allele=susceptibility

TABLE 3 Matrix metalloproteinase 12 (MMP12) −82 A/G polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A G AA AG GG ACS 249 (86%)  39 (14%) 110 (76%)  29 (20%) 5 (4%) n = 144 (%) Resistant 799 (88%) 113 (12%) 348 (76%) 103 (23%) 5 (1%) n = 456 (%) *number of chromosomes (2n) Genotype. GG vs AA/AG for ACS vs resistant smoker controls, Odds ratio (OR)=3.2, 95% confidence limits 0.8-13, χ² (Mantel-Haenszel)=3.76, p=0.05,

GG genotype=susceptibility

TABLE 4 Fibroblast growth factor 2 (FGF2) Ser 52 Ser (223 C/T) polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency C T CC CT TT ACS 252 (88%) 34 (12%) 112 (78%) 28 (20%) 3 (2%) n = 143 (%) Resistant 823 (92%) 75 (8%)  380 (85%) 63 (14%) 6 (1%) n = 449 (%) *number of chromosomes (2n) Genotype. CT/TT vs CC for ACS vs resistant smoker controls, Odds ratio (OR)=1.5, 95% confidence limits 0.9-2.5, χ² (Mantel-Haenszel)=3.1, p=0.08,

CT/TT genotype=susceptibility (CC protective)

Allele. T vs C for ACS vs resistant smoker controls, Odds ratio (OR)=1.5, 95% confidence limits 0.9-2.3, χ² (Mantel-Haenszel)=3.24, p=0.07,

T allele=susceptibility

TABLE 5 Interleukin 4 receptor alpha (IL4RA) Q576R A/G polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A G AA AG GG ACS 223 (75%)  73 (25%)  85 (57%)  53 (36%) 10 (7%) n = 148 (%) Resistant 751 (82%) 169 (18%) 303 (66%) 145 (32%) 12 (3%) n = 460 (%) *number of chromosomes (2n) Genotype. GG vs AA/AG for ACS vs resistant smoker controls, Odds ratio (OR)=2.71, 95% confidence limits 1.1-6.9, χ² (Mantel-Haenszel)=5.52, p=0.02,

GG genotype=susceptibility

Genotype. AA vs AG/GG for ACS vs resistant smoker controls, Odds ratio (OR)=0.47, 95% confidence limits 0.07-1.0, χ² (Mantel-Haenszel)=3.45, p=0.05,

AA genotype=protective

Allele. G vs A for ACS vs resistant smoker controls, Odds ratio (OR)=1.5, 95% confidence limits 1.1-2.0, χ² (Mantel-Haenszel)=5.56, p=0.02,

G allele=susceptibility

TABLE 6 Lymphotoxin alpha (LTA) Thr26Asn A/C polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A C AA AC CC ACS 117 (40%) 179 (60%) 16 (11%)  85 (57%)  47 (32%) n = 148 (%) Resistant 330 (36%) 590 (64%) 60 (13%) 210 (46%) 190 (41%) n = 460 (%) *number of chromosomes (2n) Genotype. CC vs AA/AC for ACS vs resistant smoker controls, Odds ratio (OR)=0.66, 95% confidence limits 0.4-1.0, χ² (Mantel-Haenszel)=4.28, p=0.04,

CC genotype=protective

LTA Thr26Asn A/C is in linkage disequilibrium with NFKBIL1-63 T/A

TABLE 7 Heat shock protein (HSP) 70 Hom T2437C C/T polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency C T CC CT TT ACS  46 (16%) 248 (84%)  2 (1%)  42 (29%) 103 (70%) n = 147 (%) Resistant 202 (22%) 710 (78%) 22 (5%) 158 (35%) 276 (61%) n = 456 (%) *number of chromosomes (2n) Genotype. CC/CT vs TT for ACS vs resistant smoker controls, Odds ratio (OR)=0.66, 95% confidence limits 0.43-1.0, χ² (Mantel-Haenszel)=4.33, p=0.04,

CC/CT genotype=protective (TT=susceptibility)

Allele C vs T for ACS vs resistant smoker controls, Odds ratio (OR)=0.65, 95% confidence limits 0.5-0.9, χ² (Mantel-Haenszel)=5.75, p=0.02,

C allele=protective

TABLE 8a Toll like receptor 4 (TLR4) Asp 299Gly A/G polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A G AA AG GG ACS 279 (96%) 13 (4%) 135 (92%) 9 (6%) 2 (1%) n = 146 (%) Resistant 858 (93%) 60 (7%) 399 (87%) 60 (13%) 0 (0%) n = 459 (%) *number of chromosomes (2n) Genotype. AG/GG vs AA for ACS vs resistant smoker controls, Odds ratio (OR)=0.54, 95% confidence limits 0.3-1.1, χ² (Mantel-Haenszel)=3.27, p=0.07,

AG/GG genotype=protective (AA=susceptibility)

TLR4 Asp299Gly A/G is in linkage disequilibrium with TLR4 Thr399Ile C/T

TABLE 8b Toll like receptor 4 (TLR4) Thr 399Ile C/T polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency C T CC CT TT ACS 280 (95%) 14 (5%) 135 (92%) 10 (7%)  2 (1%)   n = 147 (%) Resistant 848 (93%) 66 (7%) 392 (86%) 64 (14%) 1 (0.2%) n = 457 (%) *number of chromosomes (2n) Genotype. CT/TT vs CC for ACS vs resistant smoker controls, Odds ratio (OR)=0.54, 95% confidence limits 0.3-1.1, χ² (Mantel-Haenszel)=3.67, p=0.06,

CT/TT genotype=protective (CC=susceptibility)

TLR4 Thr399Ile C/T is in linkage disequilibrium with TLR4 Asp 299Gly A/G

TABLE 9 Interferon γ (IFNG) 874 A/T polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A T AA AT TT ACS 166 (56%) 128 (44%)  42 (29%)  82 (56%)  23 (16%) n = 147 (%) Resistant 463 (52%) 427 (48%) 127 (29%) 209 (47%) 109 (24%) n = 445 (%) *number of chromosomes (2n) Genotype. TT vs AA/AT for ACS vs resistant smoker controls, Odds ratio (OR)=0.57, 95% confidence limits 0.3-0.96, χ² (Mantel-Haenszel)=4.98, p=0.03,

TT genotype=protective

TABLE 10 Nuclear factor of K light polypeptide gene enhancer in B cells (NFKBIL1) −63 T/A polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A T AA AT TT ACS 184 (63%) 110 (37%)  52 (35%)  80 (54%) 15 (10%) n = 147 (%) Resistant 584 (66%) 304 (34%) 191 (43%) 202 (46%) 51 (11%) n = 444 (%) *number of chromosomes (2n) Genotype. AA vs AT/TT for ACS vs resistant smoker controls, Odds ratio (OR)=0.73, 95% confidence limits 0.5-1.1, χ² (Mantel-Haenszel)=2.66, p=0.10,

AA genotype=protective

NFKBIL1-63 T/A is in linkage disequilibrium with LTA Thr26Asn

TABLE 11 Platelet derived growth factor receptor alpha (PDGFRA) −1630 insertion/deletion) AACTT/Del polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency I D II ID DD ACS 239 (81%)  57 (19%)  98 (66%)  43 (29%)  7 (5%) n = 148 (%) Resistant 702 (76%) 216 (24%) 263 (57%) 176 (38%) 20 (4%) n = 459 (%) *number of chromosomes (2n): I = insertion AACTT, D = deletion Genotype. ID/DD vs II for ACS vs resistant smoker controls, Odds ratio (OR)=0.68, 95% confidence limits 0.5-1.0, χ² (Mantel-Haenszel)=3.69, p=0.05,

ID/DD genotype=protective (II susceptibility)

TABLE 12 Interleukin 4 (IL-4) −589 C/T polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency C T CC CT TT ACS 264 (90%)  28 (10%) 119 (82%)  26 (18%) 1 (1%) n = 146 (%) Resistant 792 (87%) 122 (13%) 343 (75%) 106 (23%) 8 (2%) n = 457 (%) *number of chromosomes (2n) Genotype. CT/TT vs CC for ACS vs resistant smoker controls, Odds ratio (OR)=0.68, 95% confidence limits 0.42-1.1, χ² (Mantel-Haenszel)=2.57, p=0.11,

CT/TT genotype=protective (CC=susceptibility)

TABLE 13 Matrix metalloproteinase 1 (MMP1) −1607 1G/2G polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A G 1G1G 1G2G 2G2G ACS 162 (55%) 132 (45%)  49 (33%)  64 (44%)  34 (23%) n = 147 (%) Resistant 460 (52%) 426 (48%) 118 (27%) 224 (51%) 101 (23%) n = 443 (%) *number of chromosomes (2n) Genotype. 1G1G vs 1G2G/2G2G for ACS vs resistant smoker controls, Odds ratio (OR)=1.4, 95% confidence limits 0.9-2.1, χ² (Mantel-Haenszel)=2.44, p=0.12,

1G1G genotype=susceptibility

TABLE 14 Platelet derived growth factor alpha (PDGFA) 12 IN 5 C/T polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency C T CC CT TT ACS 143 (49%) 147 (51%)  38 (26%)  67 (46%) 40 (28%) n = 145 (%) Resistant 481 (53%) 435 (47%) 122 (27%) 237 (52%) 99 (22%) n = 458 (%) *number of chromosomes (2n) Genotype. TT vs CT/CC for ACS vs resistant smoker controls, Odds ratio (OR)=1.4, 95% confidence limits 0.9-2.2, χ² (Mantel-Haenszel)=2.21, p=0.14,

TT genotype=susceptibility

TABLE 15 Glutamate-cysteine ligase modifier subunit (GCLM) −588 C/T polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency C T CC CT TT ACS 240 (81%)  56 (19%)  95 (64%)  50 (34%) 3 (2%) n = 148 (%) Resistant 778 (85%) 142 (15%) 326 (71%) 126 (27%) 8 (2%) n = 460 (%) *number of chromosomes (2n) Genotype. CT/TT vs CC for ACS vs resistant smoker controls, Odds ratio (OR)=1.4, 95% confidence limits 0.9-2.0, χ² (Mantel-Haenszel)=2.34, p=0.13,

CT/TT genotype=susceptibility (CC protective)

TABLE 16 Olfactory receptor analogue OR13G1 Ile132Val A/G polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A G AA AG GG ACS 172 (60%) 116 (40%)  51 (35%)  70 (49%) 23 (16%) n = 144 (%) Resistant 493 (54%) 421 (46%) 132 (29%) 229 (50%) 96 (21%) n = 457 (%) *number of chromosomes (2n) Genotype. AA vs AG/GG for ACS vs resistant smoker controls, Odds ratio (OR)=1.4, 95% confidence limits 0.9-2.1, χ² (Mantel-Haenszel)=2.20, p=0.14,

AA genotype=susceptibility

TABLE 17 Interleukin-10 (IL-10) −1084 A/G polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A G AA AG GG ACS 154 (53%) 136 (47%)  42 (29%)  70 (48%)  33 (23%) n = 145 (%) Resistant 434 (48%) 476 (52%) 108 (24%) 218 (48%) 129 (28%) n = 455 (%) *number of chromosomes (2n) Genotype. GG vs AA/AG for ACS vs resistant smoker controls, Odds ratio (OR)=0.74, 95% confidence limits 0.5-1.2, χ² (Mantel-Haenszel)=1.74, p=0.19,

GG genotype=protective

TABLE 18 alpha1-antitrypsin S allele Glu 288 Val A/T (M/S) polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A T AA AT TT ACS 271 (93%) 21 (7%) 126 (86%) 19 (13%) 1 (1%)   n = 146 (%) Resistant 871 (95%) 45 (5%) 414 (90%) 43 (9%)  1 (0.2%) n = 458 (%) *number of chromosomes (2n) Genotype. AT/TT vs AA for ACS vs resistant smoker controls, Odds ratio (OR)=1.5, 95% confidence limits 0.8-2.7, χ² (Mantel-Haenszel)=1.95, p=0.16,

AT/TT genotype=susceptibility

TABLE 19 Intracellular adhesion molecule 1(ICAM1) K469E A/G polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A G AA AG GG ACS 166 (56%) 130 (44%)  41 (28%)  84 (57%) 23 (16%) n = 148 (%) Resistant 529 (59%) 371 (41%) 159 (35%) 211 (47%) 80 (18%) n = 450 (%) *number of chromosomes (2n) Genotype. AA vs AG/GG for ACS vs resistant smoker controls, Odds ratio (OR)=0.70, 95% confidence limits 0.5-1.1, χ² (Mantel-Haenszel)=2.91, p=0.09,

AA genotype=protective

TABLE 20 HLA-B associated transcript 1 (BAT1) −23 C/G polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency C G CC CG GG ACS 109 (39%) 173 (61%) 16 (11%)  77 (55%)  48 (34%) n = 141 (%) Resistant 322 (35%) 586 (65%) 59 (13%) 204 (45%) 191 (42%) n = 454 (%) *number of chromosomes (2n) Genotype. GG vs CC/CG for ACS vs resistant smoker controls, Odds ratio (OR)=0.71, 95% confidence limits 0.5-1.1, χ² (Mantel-Haenszel)=2.88, p=0.09,

GG genotype=protective

TABLE 21 Nitric oxide synthase 3 (NOS3) Glu298Asp G/T polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency G T GG GT TT ACS 186 (65%) 102 (35%)  56 (39%)  74 (51%) 14 (10%) n = 144 (%) Resistant 605 (68%) 287 (32) 209 (47%) 187 (42%) 50 (11%) n = 446 (%) *number of chromosomes (2n) Genotype. GG vs GT/TT for ACS vs resistant smoker controls, Odds ratio (OR)=0.72, 95% confidence limits 0.5-1.1, χ² (Mantel-Haenszel)=2.79, p=0.09,

GG genotype=protective

TABLE 22 Superoxide dismutase 3 (SOD3) Arg213Gly C/G polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency C G CC CG GG ACS 291 (100%)  1 (0.3%) 145 (99%)  1 (1%) 0 (0%) n = 146 (%) Resistant 892 (98%) 14 (2%) 440 (97%) 12 (3%) 1 (0.2%) n = 453 (%) *number of chromosomes (2n) Genotype. CG/GG vs CC for ACS vs resistant smoker controls, Odds ratio (OR)=0.23, 95% confidence limits 0.01-1.7, χ² (Mantel-Haenszel)=2.31, p=0.13,

CG/GG genotype=protective

TABLE 23 Plasminogen activator inhibitor 1 (PAI-1) −668^(#) Del/G (4G/5G) polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency Del G Del.Del Del.G GG ACS 176 (59%) 120 (41%)  53 (36%)  70 (47%) 25 (17%) n = 148 (%) Resistant 501 (55%) 403 (45%) 148 (33%) 205 (45%) 99 (22%) n = 452 (%) *number of chromosomes (2n) ^(#)same as the PAI-1 −675 4G/5G polymorphism #same as the PAI-1-675 4G/5G polymorphism Genotype. 5G5G vs 4G5G/4G4G for ACS vs resistant smoker controls, Odds ratio (OR)=0.72, 95% confidence limits 0.4-1.2, χ² (Mantel-Haenszel)=1.7, p=0.19,

5G5G genotype=protective

TABLE 24 Macrophage inflammatory protein 1-alpha (MIP1A) 459 C/T polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency C T CC CT TT ACS 218 (77%)  64 (23%)  81 (57%)  56 (40%) 4 (3%) n = 141 (%) Resistant 688 (82%) 152 (18%) 268 (64%) 152 (36%) 0 (0%) n = 420 (%) *number of chromosomes (2n) Genotype. CT/TT vs CC for ACS vs resistant smoker controls, Odds ratio (OR)=1.31, 95% confidence limits 0.9-2.0, χ² (Mantel-Haenszel)=1.81, p=0.18,

CT/TT genotype=susceptibility

Allele. T vs C for ACS vs resistant smoker controls, Odds ratio (OR)=1.33, 95% confidence limits 0.9-1.9, χ² (Mantel-Haenszel)=2.87, p=0.09,

T allele=susceptibility

TABLE 25 Matrix metalloproteinase 7 (MMP7) −181 A/G polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A G AA AG GG ACS 171 (58%) 125 (42%)  42 (28%)  87 (59%) 19 (13%) n = 148 (%) Resistant 526 (57%) 392 (43%) 147 (32%) 232 (51%) 80 (17%) n = 459 (%) *number of chromosomes (2n) Genotype. GG vs AA/AG for ACS vs resistant smoker controls, Odds ratio (OR)=0.70, 95% confidence limits 0.4-1.2, χ² (Mantel-Haenszel)=1.73, p=0.19,

GG genotype=protective

TABLE 26 Cathepsin G Asn125Ser A/G polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency A G AA AG GG ACS 279 (96%) 11 (4%) 135 (93%)  9 (6%) 1 (1%) n = 145 (%) Resistant 846 (94%) 52 (6%) 398 (89%) 50 (11%) 1 (0.2%) n = 449 (%) *number of chromosomes (2n) Genotype. AG/GG vs AA for ACS vs resistant smoker controls, Odds ratio (OR)=0.58, 95% confidence limits=0.27-1.22, χ² (Mantel-Haenszel)=2.36, p=0.12,

AG/GG genotype=protective (AA susceptibility)

TABLE 27 Chemokine (CX3C motif) receptor 1 (CX3CR1) I249V C/T polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency C T CC CT TT ACS 201 (69%)  91 (31%)  74 (51%)  53 (36%) 19 (13%) n = 146 (%) Resistant 651 (71%) 265 (29%) 234 (51%) 183 (40%) 41 (9%) n = 458 (%) number of chromosomes (2n) Genotype. TT vs CC/CT for ACS vs resistant smoker controls, Odds ratio (OR)=1.5, 95% confidence limits=0.82-2.81, χ² (Mantel-Haenszel)=2.04, p=0.15,

TT genotype=susceptibility

TABLE 28 Caspase (NOD2) Gly881Arg G/C polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency C G CC CG GG ACS 6 (2%) 288 (98%) 0 (0%) 6 (4%) 141 (96%) n = 147 (%) Resistant 9 (1%) 905 (99%) 0 (0%) 9 (2%) 448 (98%) n = 457 (%) *number of chromosomes (2n) Genotype. CC/CG vs GG for ACS vs resistant smoker controls, Odds ratio (OR)=2.1, 95% confidence limits=0.662-6.6, χ² (Mantel-Haenszel)=2.05, p=0.15,

CC/CG genotype=susceptibility

TABLE 29 Tissue inhibitor of metalloproteinase 1 (TIMP1) 372 T/C polymorphism allele and genotype frequencies in the ACS patients and resistant smokers. Allele* Genotype Frequency C T CC CT TT ACS 202 (68%)  94 (32%)  64 (43%)  74 (50%) 10 (7%) n = 148 (%) Resistant 517 (57%) 397 (43%) 158 (35%) 201 (44%) 98 (21%) n = 457 (%) number of chromosomes (2n) Genotype. TT vs CT/CC for ACS vs resistant smoker controls, Odds ratio (OR)=0.27, 95% confidence limits=0.13-0.54, χ² (Mantel-Haenszel)=16.42, p=0.00005,

TT genotype=protective

Genotype. CC vs CT/TT for ACS vs resistant smoker controls, Odds ratio (OR)=1.4, 95% confidence limits=1.0-2.1, χ² (Mantel-Haenszel)=3.61, p=0.06,

CC genotype=susceptibility

Allele T vs C, ACS vs resistant smoker controls, Odds ratio (OR)=0.61, 95% confidence limits=0.45-0.81, χ² (Mantel-Haenszel)=12.64, p=0.0004,

T allele=protective

Table 30 below presents a summary of the protective and susceptibility SNPs identified herein. Selected susceptibility SNPs are identified as S1 through S13, while selected protective SNPs are identified as P1 through P16. Those shown in bold were included in panels of SNPs used to generate a SNP score as discussed below.

TABLE 30 Summary of Protective and susceptibility SNPs for Acute Coronary Syndrome Gene rs Polymorphism Genotype SNP# Phenotype OR P value CMA1 1800875 −1903 A/G GG S1 susceptibility 1.9 0.004 TGFB1 1800469 −509 C/T CC S2 susceptibility 1.5 0.05 MMP12 2276109 −82 A/G GG S3 susceptibility 3.2 0.05 FGF2 1449683 Ser52Ser 223 C/T CT/TT S4 susceptibility 1.5 0.08 (CC) (protective) IL4RA 1801275 Q576R A/G GG S5 susceptibility 2.7 0.02 AA protective 0.47 0.05 LTA 1041981 Thr26Asn A/C CC P1 protective 0.66 0.04 HSP70 2227956 Hom T2437C CC/CT P2 protective 0.66 0.04 (TT) (susceptibility) TLR4 4986790 ¹Asp299Gly A/G AG/GG P3 protective 0.54 0.07 (AA) (susceptibility) TLR4 4986791 ²Thr399Ile C/T CT/TT P3.1 protective 0.54 0.06 (CC) (susceptibility) IFNG 2430561 874 A/T TT P4 protective 0.57 0.03 NFKBIL1 2071592 −63 T/A AA P11 protective 0.73 0.10 PDGFRA — −1630 I/D, I/Del, Del/Del P5 protective 0.68 0.05 (AACTT/Del) (II) (susceptibility) IL4 2243250 −589 C/T CT/TT P6 protective 0.68 0.11 (CC) (susceptibility) MMP1 1799750 −1607 1G/2G (Del/G) Del.Del (ie S6 susceptibility 1.4 0.12 1G1G) PDGFA — 12 IN5 C/T TT S7 susceptibility 1.4 0.14 GCLM — −588 C/T CT/TT S8 susceptibility 1.4 0.13 (CC) (protective) OR13G1 1151640 Ile132Val A/G AA S9 susceptibility 1.4 0.14 IL-10 1800896 −1084 A/G (−1082) GG P12 protective 0.74 0.19 α1-AT S 17580 Glu288Val A/T AT/TT S10 susceptibility 1.5 0.16 allele (M/S) (MS/SS) ICAM1 5498 K469E A/G AA P7 protective 0.70 0.09 BAT1 2239527 −23 C/G GG P8 protective 0.71 0.09 NOS3 1799983 Glu298Asp G/T GG P9 protective 0.72 0.09 SOD3 1799895 Arg213Gly C/G CG/GG P10 protective 0.23 0.13 PAI-1 — −668 4G/5G 5G5G P13 protective 0.72 0.19 MIP1A 1719134 +459 C/T Intron 1 CT/TT S11 susceptibility 1.31 0.18 MMP7 17880821 −181 A/G GG P14 protective 0.70 0.19 Cathepsin G Asn 125Ser AG/GG P15 protective 0.58 0.12 AA (susceptibility) CX3CR1 3732379 I249V TT S12 susceptibility 1.5 0.15 NOD2 2066845 Gly 881 Arg G/C CC/CG S13 susceptibility 2.1 0.15 TIMP1 4898 372 T/C TT P16 protective 0.27 0.00005 CC susceptibility 1.4 0.06

As discussed herein, S3 is in LD with S6, P1 is in LD with P11 and P3 is in LD with P3.1. Hence, these SNPs were not used together in a panel when deriving the SNP score. Table 31 below shows the distribution of ACS patients and smoking controls with reference to a SNP score. The SNP score for each individual was determined in a combined analysis of an 11 SNP panel consisting of SNPs S1-S5 and P1-P6 as shown in Table 30. Each susceptibility SNP was assigned a value of +1, and each protective SNP was assigned a value of −1. FIG. 1 presents this data graphically.

TABLE 31 Distribution of those with ACS according to SNP score - 11 SNP panel. SNP score based on 11 SNP panel Cohort <−4 −3 −2 −1 0 1 2+ total Smoking controls 18 53 88 129 107 51 14 460 ACS  1  8 13  37  46 24 19 148 % with ACS 1/19 8/61 13/101 37/166 46/153 24/75 19/33 608 5% 13% 13% 22% 30% 32% 58% Table 32 below shows the distribution of ACS patients and smoking controls according to the SNP score determined with reference to a larger, 15 SNP, panel. This 15 SNP panel consisted of SNPs S1-S5 and P1-P10 as shown in Table 30. Again, each susceptibility SNP was assigned a value of +1, and each protective SNP was assigned a value of −1. FIG. 2 presents the data shown in Table 32 graphically.

TABLE 32 Distribution of those with ACS according to SNP score - 15 SNP panel. SNP score based on 15 SNP panel Cohort <−6 −5 −4 −3 −2 −1 0 1 2+ Total Smoking controls 22 35 55 84 98 83 60 21  2 460 ACS  0  6 12 16 26 38 21 18 11 148 % with ACS 0/22 6/41 12/67 16/100 26/124 38/121 21/81 18/39 11/13 608 0% 15% 18% 16% 21% 31% 26% 46% 84% % with ACS (by grouping 6/63 28/167 26/124 49/202 29/52 comparable risk scores) 10% 17% 21% 29% 56%

Discussion

The above results show that several polymorphisms were associated with either increased or decreased risk of developing ACS. The associations of individual polymorphisms on their own, while of discriminatory value, are unlikely to offer an acceptable prediction of disease. However, in combination these polymorphisms distinguish susceptible subjects from those who are resistant (for example, between the smokers who develop ACS and those with the least risk with comparable smoking exposure). The polymorphisms represent both promoter polymorphisms, thought to modify gene expression and hence protein synthesis, and exonic polymorphisms known to alter amino-acid sequence (and likely expression and/or function) in a number of genes encoding proteins central to processes including inflammation, matrix remodelling, and cytokine activity.

In the comparison of smokers with ACS and matched smokers without ACS (lowest risk for ACS despite smoking), several polymorphisms were identified as being found in significantly greater or lesser frequency than in the comparator group. Due to the small cohort of ACS patients, polymorphisms where there are only trends towards differences (P=0.06-0.25) were included in the analyses, although in the combined analyses only those polymorphisms with the most significant differences were utilised.

-   -   In the analysis of the −1903 A/G polymorphism of the Chymase 1         gene, the GG genotype was found to be greater in the ACS cohort         (OR=1.9, P=0.004) consistent with a susceptibility role (see         Table 1). The G allele was also found to be significantly         greater in the ACS cohort compared to the resistant smoking         cohort (OR=1.4, p=0.01) consistent with a susceptibility role         (Table 1).     -   In the analysis of the −509 C/T in the TGFB1 gene, the CC         genotype was found to be greater in the ACS cohort compared to         the resistant smoker cohort (OR=1.5, p=0.05) consistent with a         susceptibility role (see Table 2). The C allele was also found         to be significantly greater in the ACS cohort compared to the         resistant smoker cohort (OR=1.4, p=0.05) consistent with a         susceptibility role (Table 2).     -   In the analysis of the −82 A/G polymorphism in the MMP12 gene,         the GG genotype was found to be greater in the ACS cohort         compared to the resistant smoker cohort (OR=3.2, p=0.05)         consistent with a susceptibility role (see Table 3).     -   In the analysis of the Ser52Ser (223 C/T) polymorphism of the         FGF2 gene, the CT and TT genotypes were found to be greater in         the ACS cohort compared to the resistant smoker cohort (OR=1.5,         p=0.08) consistent with each having a susceptibility role. The T         allele was found to be greater in the ACS cohort compared to the         resistant smoker cohort (OR=1.5, p=0.07) consistent with a         susceptibility role. In contrast, the CC genotype was found to         be consistent with a protective role (Table 4).     -   In the analysis of the Q576R A/G polymorphism of the IL4RA gene,         the GG genotype was found to be greater in the ACS cohort         compared to the resistant smoker cohort (OR=2.71, p=0.02)         consistent with a susceptibility role (see Table 5). The G         allele was also found to be significantly greater in the ACS         cohort compared to the resistant smoker cohort (OR=1.5, p=0.02)         consistent with a susceptibility role (Table 5). In contrast the         AA genotype was found to be greater in the resistant smoker         cohort compared to the ACS cohort (OR=0.47, p=0.05) consistent         with a protective role (see Table 5).     -   In the analysis of the Thr26Asn A/C polymorphism of the LTA         gene, the CC genotype was found to be greater in the resistant         smoker cohort compared to the ASC cohort (OR=0.66, p=0.04)         consistent with a protective role (see Table 6).     -   In the analysis of the HOM T2437C C/T polymorphism of the HSP 70         gene, the CC and CT genotypes were found to be greater in the         resistant smoker cohort compared to the ACS cohort (OR=0.66,         p=0.04) consistent with each having a protective role (see Table         7). The C allele was also found to be greater in the resistant         smoker cohort compared to the ACS cohort (OR=0.65, p=0.02)         consistent with a protective role. In contrast the TT genotype         was found to be consistent with a susceptibility role (see Table         7).     -   In the analysis of the Asp299Gly A/G polymorphism of the TLR4         gene, the AG and GG genotypes were found to be greater in the         resistant smoker cohort compared to the ACS cohort (OR=0.54,         p=0.07) consistent with each having a protective role (see Table         8a). In contrast, the AA genotype was found to be consistent         with a susceptibility role (see Table 8a).     -   In the analysis of the Thr399Ile C/T polymorphism of the TLR4         gene, the CT and TT genotypes were found to be greater in the         resistant smoker cohort compared to the ACS cohort (OR=0.54,         p=0.06) consistent with each having a protective role (see Table         8b). In contrast the CC genotype was found to be consistent with         a susceptibility role (Table 8b).     -   In the analysis of the 874 A/T polymorphism of the IFNG gene,         the TT genotype was found to be greater in the resistant smoker         cohort compared to the ACS cohort (OR=0.57, p=0.03) consistent         with a protective role (see Table 9).     -   In the analysis of the −63 T/A polymorphism of the NFKBIL1 gene,         the AA genotype was found to be greater in the resistant smoker         cohort compared to the ACS cohort (OR=0.73, p=0.10) consistent         with a protective role (see Table 10).     -   In the analysis of the −1630 Ins/Del (AACTT/Del) polymorphism of         the PDGFRA gene, the Ins Del and Del Del genotypes were found to         be greater in the resistant smoker cohort compared to the ACS         cohort (OR=0.68, p=0.05) consistent with each having a         protective role (Table 11). In contrast the Ins Ins was found to         be consistent with a susceptibility role (see Table 11).     -   In the analysis of the −589 C/T polymorphism of the IL-4 gene,         the CT and TT genotypes were found to be greater in the         resistant smoker cohort compared to the ACS cohort (OR=0.68,         p=0.11) consistent with each having a protective role (see Table         12). In contrast the CC genotype was found to be consistent with         a susceptibility role (Table 12).     -   In the analysis of the −1607 1G/2G polymorphism of the MMP1         gene, the 1G1G genotype was found to be greater in the ACS         cohort compared to the resistant smoker cohort (OR=1.4, p=0.12)         consistent with a susceptibility role (see Table 13).     -   In the 12 IN 5 C/T polymorphism of the PDGFA gene, the TT         genotype was found to be greater in the ACS cohort compared to         the resistant smoker cohort (OR=1.4, p=0.14) consistent with a         susceptibility role (see Table 14).     -   In the −588 C/T polymorphism in the GCLM gene, the CT and TT         genotypes were found to be greater in the ACS cohort compared to         the resistant smoker cohort (OR=1.4, p=0.13) consistent with         each having a susceptibility role (see Table 15). In contrast,         the CC genotype was found to be consistent with a protective         role (see Table 15).     -   In the Ile32Val A/G polymorphism of the OR13G1 gene, the AA         genotype was found to be greater in the ACS cohort compared to         the resistant smoker cohort (OR=1.4, p=0.14) consistent with a         susceptibility role (Table 16).     -   In the analysis of the −1084 A/G polymorphism of the 11-10 gene,         the GG genotype was found to be greater in the resistant smoker         cohort compared to the ACS cohort (OR=0.74, p=0.19) consistent         with a protective role (see Table 17).     -   In the analysis of the Glu288Val A/T (M/S) polymorphism in the         α1-AT gene, the AT and TT genotypes were found to be greater in         the ACS cohort compared to the resistant smoker cohort (OR=1.5,         p=0.16) consistent with each having a susceptibility role (see         Table 18).     -   In the K469E A/G polymorphism in the ICAM1 gene, the AA genotype         was found to be greater in the resistant smoker cohort compared         to the ACS cohort (OR=0.70, p=0.09) consistent with a protective         role (see Table 19).     -   In the analysis of the −23 C/G polymorphism of the BAT1 gene,         the GG genotype was found to be greater in the resistant smoker         cohort compared to the ACS cohort (OR=0.71, p=0.09) consistent         with a protective role (see Table 20).     -   In the analysis of the Glu298Asp (G/T) polymorphism of the         Nitric oxide synthase 3 gene, the GG genotype was found to be         greater in the smoking resistant cohort compared to the ACS         cohort (OR=0.72, p=0.09) consistent with a protective role (see         Table 21).     -   In the analysis of the Arg213Gly C/G polymorphism of the SOD3         gene, the CG and GG genotypes were found to be greater in the         resistant smoker cohort compared to the ACS cohort (OR=0.23,         p=0.13) consistent with each having a protective role (see Table         22).     -   In the analysis of the −668 Del/G (4G/5G) polymorphism of the         PAI-1 gene, the 5G5G genotype was found to be greater in the         resistant smoker cohort compared to the ACS cohort (OR=0.72,         p=0.19) consistent with a protective role (see Table 23).     -   In the analysis of the 459 C/T polymorphism of the MIP1A gene,         the CT and TT genotypes were found to be greater in the ACS         cohort compared to the resistant smoker cohort (OR=1.31, p=0.18)         consistent with each having a susceptibility role (see Table         24). The T allele was also found to be greater in the ACS cohort         compared to the resistant smoker cohort (OR=1.33, p=0.09)         consistent with a susceptibility role (Table 24).     -   In the analysis of the −181 A/G polymorphism of the MMP7 gene,         the GG genotype was found to be greater in the resistant smoker         cohort compared to the ACS cohort (OR=0.70, p=0.19) consistent         with a protective role (see Table 25).     -   In the analysis of the Asn125Ser A/G polymorphism of the         Cathespin G gene, the AG and GG genotypes were found to be         greater in the resistant smoker cohort compared to the ACS         cohort (OR=0.58, p=0.12) consistent with each having a         protective role (see Table 26). In contrast the AA genotype was         found to be consistent with a susceptibility role (Table 26).     -   In the I249V C/T polymorphism of the CX3CR1 gene, the TT         genotype was found to be greater in the ACS cohort compared to         the resistant smoker cohort (OR=1.5, p=0.15) consistent with a         susceptibility role (Table 27).     -   In the analysis of the Gly881Arg G/C polymorphism in the NOD2         gene, the CC and CG genotypes were found to be greater in the         ACS cohort compared to the resistant smoker cohort (OR=2.1,         p=0.15) consistent with each having a susceptibility role (see         Table 28).     -   In the analysis of the 372 T/C polymorphism of the TIMP1 gene,         the TT genotype was found to be greater in the resistant smoker         cohort compared to the ACS cohort (OR=0.27, p=0.00005)         consistent with a protective role (see Table 29). The T allele         was also found to be significantly greater in the resistant         smoker cohort compared to the ACS cohort (OR=0.61, p=0.0004)         consistent with a protective role (Table 29). In contrast the CC         genotype was found to be greater in the ACS cohort compared to         the resistant smoker cohort (OR=1.4, p=0.06) consistent with a         susceptibility role (see Table 29).

It is accepted that the disposition to ACS is the result of the combined effects of the individual's genetic makeup and other factors, including their lifetime exposure to various aero-pollutants including tobacco smoke. Similarly, it is accepted that ACS encompasses several vascular diseases. The data herein suggest that several genes can contribute to the development of ACS. A number of genetic mutations working in combination either promoting or protecting the vasculature from damage are likely to be involved in elevated resistance or susceptibility to ACS.

From the analyses of the individual polymorphisms, 20 susceptibility genotypes and 20 protective genotypes were identified and analysed for their frequencies in the smoker cohort consisting of resistant smokers and those with ACS. In a pre-defined algorithm, where the presence of a susceptibility genotype scores +1 and the presence of a protective genotype scores −1, an ACS SNP score has been generated for each subject. The ACS SNP score generated with reference to an 11 SNP panel is linearly related to the frequency of having ACS. For example, the chance of having ACS diminished from 58% in smokers with a SNP score of +2 to 5% in smokers with a SNP score of −4 or less (see Table 31 and FIG. 1). In a further analysis with a 15 SNP panel consisting of the SNPs S1-S5 and P1-P10 as shown in Table 30, the chance of having ACS diminished from 84% in smokers with a SNP score of 2 or greater, to 0% in smokers with a SNP score of −6 or less (see Table 32 and FIG. 2).

Furthermore, the log odds of having ACS is linearly related to the ACS SNP score—the greater the SNP score, the greater likelihood of having an acute coronary syndrome (see FIG. 3). From preliminary analyses of the C statistic (equivalent to the area under the curve of a receiver operator curve that optimises sensitivity and specificity of a test), the C statistic values are as follows: SNP score alone=0.65, SNP score/age=0.74, SNP score/BMI/gender=0.78 and SNP score/BMI/gender/age=0.93.

Thus, the ACS SNP score is independently associated with having ACS and can be used alone or in conjunction with non-genetic risk factors to assess risk of ACS and of having an acute coronary event.

These findings indicate that the methods of the present invention may be predictive of ACS in an individual well before symptoms present.

These findings therefore also present opportunities for therapeutic interventions and/or treatment regimens, as discussed herein. Briefly, such interventions or regimens can include the provision to the subject of motivation to implement a lifestyle change, or therapeutic methods directed at normalising aberrant gene expression or gene product function. For example, as shown herein the −675 5G5G genotype in the promoter of the PAI-1 gene is associated with decreased risk of developing ACS. The 5G allele is reportedly associated with increased binding of a repressor protein and decreased transcription of the gene. A suitable therapy for individuals having the −675 4G4G genotype can be the administration of an agent capable of increasing the level of repressor and/or enhancing binding of the repressor, thereby augmenting its downregulatory effect on transcription. An alternative therapy can include gene therapy, for example the introduction of at least one additional copy of a gene encoding a repressor having an increased affinity for binding a PAI-1 gene having a −675 4G4G genotype. In a further example, as shown herein the −82 A/G GG genotype in the promoter of the gene encoding MMP12 is associated with susceptibility to ACS. A number of inhibitors of matrix metalloproteinases are known, for example those discussed in U.S. Pat. No. 6,600,057 (incorporated herein in its entirety), such as tissue inhibitors of metalloproteinases (TIMPs) including TIMP1, TIMP2, TIMP3, and TIMP4, which form inactive complexes with MMPs, more general proteinase regulators which prevent MMP action, regulators of MMP gene expression including membrane bound MMPs (MT-MMP) that activate the excreted proenzyme form of MMPs, and compounds such as 4,5-dihydroxyanthaquinone-2-carboxylic acid (AQCA) and derivatives thereof. A suitable therapy in subjects known to possess the −82 A/G GG genotype can be the administration of an agent capable of reducing expression of the gene encoding MMP12, or administration of an agent capable of reducing the activity of MMP12, for example by administration of an agent capable of increasing expression of or the activity of one or more TIMPs, or administration of an agent capable of reducing expression of or the activity of one or more membrane bound MMPs or other activators of MMP12. For example, a suitable therapy can be the administration to such a subject of a MMP1 inhibitor such as 4,5-dihydroxyanthaquinone-2-carboxylic acid (AQCA), anthraquinyl-mercaptoethyamine, anthraquinyl-alanine hydroxamate, or derivatives thereof. Similarly, the 372 T/C CC genotype in the gene encoding TIMP1 is associated with susceptibility to ACS. A suitable therapy in subjects known to possess the 372 T/C CC genotype can be the administration of an agent capable of modulating, and preferably increasing, the expression of the gene encoding TIMP1.

In another example; a given susceptibility genotype is associated with increased expression of a gene relative to that observed with the protective genotype. A suitable therapy in subjects known to possess the susceptibility genotype is the administration of an agent capable of reducing expression of the gene, for example using antisense or RNAi methods. An alternative suitable therapy can be the administration to such a subject of an inhibitor of the gene product. In still another example, a susceptibility genotype present in the promoter of a gene is associated with increased binding of a repressor protein and decreased transcription of the gene. A suitable therapy is the administration of an agent capable of decreasing the level of repressor and/or preventing binding of the repressor, thereby alleviating its downregulatory effect on transcription. An alternative therapy can include gene therapy, for example the introduction of at least one additional copy of the gene having a reduced affinity for repressor binding (for example, a gene copy having a protective genotype).

Suitable methods and agents for use in such therapy are well known in the art, and are discussed herein.

The identification of both susceptibility and protective polymorphisms as described herein also provides the opportunity to screen candidate compounds to assess their efficacy in methods of prophylactic and/or therapeutic treatment. Such screening methods involve identifying which of a range of candidate compounds have the ability to reverse or counteract a genotypic or phenotypic effect of a susceptibility polymorphism, or the ability to mimic or replicate a genotypic or phenotypic effect of a protective polymorphism.

Still further, methods for assessing the likely responsiveness of a subject to an available prophylactic or therapeutic approach are provided. Such methods have particular application where the available treatment approach involves restoring the physiologically active concentration of a product of an expressed gene from either an excess or deficit to be within a range which is normal for the age and sex of the subject. In such cases, the method comprises the detection of the presence or absence of a susceptibility polymorphism which when present either upregulates or downregulates expression of the gene such that a state of such excess or deficit is the outcome, with those subjects in which the polymorphism is present being likely responders to treatment.

Example 2

This example describes the substitution of SNPs identified herein as being associated with risk of ACS with SNPs in linkage disequilibrium, and shows that such SNPs can have comparable utility in deriving a SNP score. Here, alternative SNPs can be used to derive a SNP score when SNPs in LD are substituted for the specific SNPs recited herein. To illustrate this, the TLR4 Asp299Gly A/G SNP was substituted with the TLR4 Thr399Ile C/T SNP in the 11 SNP panel. These two SNPs are reported to be in linkage disequilibrium (the G allele of the Asp299Gly polymorphism reportedly nearly always cosegregates with the T allele of the Thr399Ile polymorphism). This cosegregation is clearly shown in Table 33 below, where there is 99% concordance between the genotypes of the Asp299Gly polymorphism and Thr399Ile polymorphism (genotyping “fails” are excluded).

TABLE 33 Concordance between the TLR4 299 and 399 polymorphisms. TLR4 299 genotype TLR4 399 genotype Concordance (%) Totals AA 534 CC 524 524/530 534 TC 6 (99%) Fails 4 AG 69 TC 68 68/69 69 TT 1 (99%) GG 2 TT 2 2/2 2 (100%)  Fails 3 CC 3 3 608

Table 34 shows the distribution of SNP score in the ACS and control groups when the TLR4 Asp299Gly SNP is replaced with the TLR4 Thr399Ile SNP for the 11 SNP panel. In deriving the SNP score this means substituting the score for the AG/GG genotype (protective=+1) with the score for the CT/TT genotype (protective=+1) and calculating the score with the latter. The shaded cells in Table 34 identify differences with respect to the comparable groups shown in Table 31. The graph depicted in FIG. 4 shows the score graphically and is similar to that of FIG. 1.

TABLE 34 Distribution of those with ACS according to SNP score—substituted 11 SNP panel SNP score based on 11 SNP panel total Cohort <−4 −3 −2 −1  0  1  2+ Smoking controls  18

107 

14 460 ACS  1  8 13 37

19 148 % with ACS 1/19 8/62 13/102 37/165 47/154 23/73 19/33 608 5% 13% 13% 22% 31% 32% 58%

Therefore, SNPs that are in LD with the SNPs used herein to derive a SNP score may be substituted with SNPs in LD to derive a clinically meaningful score.

Table 35 below presents representative examples of polymorphisms in linkage disequilibrium with the polymorphisms specified herein in Table 30. Examples of such polymorphisms can be located using public databases, such as that available at www.hapmap.org. Specified polymorphisms are indicated in parentheses. As those skilled in the art will recognise, the rs numbers provided are identifiers unique to each polymorphism.

These results show that SNPs in LD with the SNPs recited herein, such as those from Table 35, could be utilised in a SNP score with similar clinical utility.

TABLE 35 SNPs in linkage disequilibrium with the SNPs associated with either a susceptibility or protective phenotype. CMA1 rs7150627 rs2007323 rs11844710 rs7151943 rs7148705 rs1885107 rs9806075 rs4982956 rs1956920 rs7146705 rs12434912 rs1956921 rs2208447 rs927281 rs1800875 (−1903 A/G) rs7400965 rs761988 rs1800876 rs6573850 rs1956916 rs3759635 rs8007723 rs1956917 rs1956922 rs927278 rs1956918 rs1956923 rs2007316 rs1956919 TGFB1 rs1529717 rs13447341 rs1046909 rs2241712 rs2241714 rs1982072 rs2317130 rs4803457 rs1800469 rs1982073 rs1800471 (−509 C/T) MMP12 rs17368890 rs11225444 rs608194 rs12793969 rs1277718 rs4323842 rs17099726 rs7931510 rs12786343 rs7934568 rs17099720 rs4420231 rs7934710 rs3814766 rs4393288 rs621170 rs2276109 rs11225443 rs11225445 rs10895367 (−82 A/G) rs17368659 rs636648 rs495914 rs7126998 rs17368814 rs610341 rs1799750 rs501371 rs610338 (MMP1 −1607 G/GG) FGF2 rs13434728 rs308395 rs12509901 rs308405 rs13434738 rs308396 rs177814 rs308404 rs308447 rs308397 rs308412 rs10470916 rs13435470 rs308398 rs1563704 rs308403 rs10003693 rs308399 rs10049563 rs308402 rs11940812 rs308400 rs308411 rs308401 rs13137174 rs1449683 rs308410 rs10028307 rs2922979 rs416124 (Ser52Ser) rs7668232 rs3804144 rs374880 rs13349352 rs2922980 rs308409 rs11940156 rs12650248 rs4574429 rs308391 rs1992980 rs308408 rs12507250 rs2922981 rs367344 rs308392 rs1984971 rs367331 rs11098673 rs366192 rs308407 rs6828763 rs411027 rs968346 rs6829351 rs421184 rs4254785 rs308393 rs2926173 rs728694 rs6830094 rs11934448 rs13119363 rs308394 rs4146526 rs308406 IL4RA rs3024672 rs1805012 rs3024696 rs2234899 rs3024673 rs2234923 rs3024674 rs2234900 rs3024675 rs1805013 rs3024676 rs1805015 rs2234897 rs1801275 rs6413500 (Q576R) rs3024677 rs1805011 rs3024678 rs2234898 rs1805016 LTA rs2857708 rs3093540 rs4645834 rs4947326 rs2516312 rs3093547 rs4947327 rs2844482 rs3093545 rs2844486 rs2071590 rs4248157 rs2857601 rs1800683 rs9282875 rs2844485 rs2239704 rs1799964 rs3131637 rs3093546 rs4647198 rs7449641 rs909253 rs9282876 rs12174951 rs4986978 rs2507961 rs3135048 rs746868 rs1800630 rs2844484 rs4647193 rs2844483 rs4647194 rs9267499 rs2857713 rs2857706 rs3093542 rs2009658 rs3093543 rs3093539 rs2071589 rs736160 rs1041981 rs915654 (Thr26Asn) rs4647195 rs4647191 rs4647196 rs4647192 rs3093544 HSP70 rs547828 rs11557921 rs2075800 rs1061581 rs2227956 rs506770 rs1008438 rs541340 (T2437C) rs1043618 rs508603 rs11557923 rs508633 rs1043620 rs562047 rs12190359 rs11557924 TLR4 rs2149356 rs5030714 rs5030727 rs4986790 rs5030728 (Asp299Gly) rs2770145 rs5030729 rs2770144 rs100001066 rs5031050 rs5030710 rs11536884 rs5030711 rs4986791 rs5030712 (Thr399Ile) rs16906079 rs5030713 IFNG rs2069705 rs2069713 rs2069719 rs2069724 rs2069731 rs1861494 rs9282708 rs2069725 rs2069706 rs2234685 rs2069720 rs4394909 rs2069707 rs1861493 rs1042274 rs2069726 rs3814242 rs2069714 rs2069721 rs2069727 rs2069709 rs2069715 rs2069734 rs2069710 rs2069716 rs2069722 rs2069711 rs2069717 rs2234687 rs2069712 rs2069718 rs7957366 rs2430561 rs3087272 rs2069723 (874 A/T) NFKBIL1 rs2071592 rs2844492 rs12181589 rs3869143 rs2857710 (−63 T/A) rs2516386 rs2523500 rs11756780 rs4081553 rs3131641 rs2516385 rs2523499 rs2857606 rs4947324 rs2844490 rs11962114 rs9267491 rs2516395 rs4947325 rs2844489 rs2239708 rs2516383 rs9267493 rs2516479 rs2857709 rs2071591 rs7749930 rs12526552 rs13215091 rs2844488 rs9380262 rs6916921 rs12200955 rs2516392 rs2844487 rs3219183 rs9378162 rs3130061 rs2516391 rs2857602 rs9267489 rs7754479 rs13220163 rs2857603 rs2857708 rs3219182 rs11752951 rs13220165 rs2516390 rs4947326 rs3219181 rs11752976 rs2857605 rs9501149 rs4947327 rs3219180 rs2255798 rs2857604 rs9267494 rs2844486 rs2857607 rs9267492 rs3093949 rs6903106 rs2857601 rs9267490 rs3094594 rs2239707 rs928815 rs2844485 rs9394075 rs2516397 rs3219179 rs7762619 rs3131637 rs2516384 rs2516396 rs2230365 rs12663590 rs7449641 rs13190709 rs2255899 rs3130062 rs7746486 rs12174951 rs2523501 rs9394076 rs13192469 rs3135043 rs3135048 rs7738380 rs12661769 rs9469024 rs3135042 rs2844484 rs11751074 rs6929796 rs4288225 rs2523514 PDGFRA rs7682912 rs17084062 rs890203 rs2412555 rs4484359 rs17084065 rs4864861 rs11941325 rs12649484 rs2114039 rs4864504 rs11942406 rs7683707 rs13140747 rs4608869 rs11944066 rs12506783 rs13114391 rs4368668 rs4422471 rs17084050 rs17084067 rs4635872 rs10029499 rs17084051 (−1630 I/D) rs6850748 rs4637467 rs7673597 rs1800809 rs4864862 rs7677751 rs7673625 rs6554162 rs4864505 rs7673984 rs1800810 rs4864863 rs4352534 rs1800813 rs4864844 rs4394060 rs1135534 rs7678144 rs4508953 rs1800812 rs6554163 rs4864857 rs7690503 rs6836215 rs4864858 rs7673027 rs6554164 rs4864859 rs7668190 rs11727127 rs4864860 rs7689569 rs11937644 rs7698425 rs12644271 rs13435164 rs7681399 rs7673853 rs6554165 rs6839108 rs7679903 rs6842432 IL4 rs2243250 rs2243261 rs2243280 rs10066662 rs4986963 (−589 C/T) rs2227282 rs2243281 rs6885996 rs17772853 rs2243263 rs6879348 rs13181331 rs2070874 rs2243264 rs2243282 rs13161530 rs2243251 rs2243265 rs2243283 rs4426908 rs4986964 rs2243266 rs2243284 rs7731792 rs2243252 rs2243267 rs2243285 rs11749544 rs2079102 rs2243268 rs7703922 rs6897429 rs734244 rs9282745 rs12521281 rs2406539 rs2243253 rs9282746 rs2243286 rs11747814 rs4996002 rs2243270 rs2243287 rs10043403 rs9327636 rs2243308 rs2243309 rs11242122 rs9327637 rs2243271 rs2243288 rs11242123 rs2243254 rs2243272 rs2243289 rs11242124 rs2243255 rs2243273 rs2243290 rs11242125 rs2243257 rs2243274 rs2243291 rs6879672 rs2243258 rs2243275 rs2243292 rs1859139 rs2243259 rs2243276 rs7379604 rs1859138 rs2227284 rs2243277 rs7379607 rs10068370 rs2243260 rs2243279 rs10066660 rs11949166 MMP1 rs498186 rs509332 rs570662 rs575727 rs473509 rs534191 rs7125865 rs7102189 rs2075847 rs1155764 rs2000609 rs573764 rs470146 rs7107224 rs2839969 rs574939 rs1799750 rs685265 rs12283571 rs542603 (−1607 1G/2G) rs470211 rs12279710 rs519806 rs12280880 rs533621 rs2408490 rs12285331 rs526215 rs470206 rs470307 rs12286876 rs504875 rs2105581 rs484915 rs634607 rs12283759 rs11225427 rs552306 PDGFA rs1800815 no rs number His69His rs1800814 C − 26IN3T (C + 12IN5T) GCLM rs3170633 rs2234730 rs12094906 rs2273407 rs10489605 rs6703130 rs7515991 rs2273406 rs12094966 rs11165031 rs12057371 rs12401915 rs7549683 rs6667121 rs12068345 rs743119 rs7513671 rs1803636 rs11165033 rs736762 rs10874809 rs11165032 rs7527855 no rs number rs7552401 (−588 C/T) rs12062047 rs3827715 rs6700112 rs11589165 rs17376966 rs12040570 rs11587480 rs2234729 rs12090038 rs12062214 rs6680315 rs4598495 rs12062216 rs6541405 rs12090230 rs12760946 rs12730517 rs6692306 rs12089163 rs7541690 rs6702045 rs12140446 rs718873 rs6702064 rs7522297 rs718874 rs2391323 rs7517826 rs718875 rs2064764 rs7515191 rs12741834 rs12143416 rs1803635 rs12410324 rs12064127 rs12068168 rs2301022 rs769211 rs7515813 rs3789453 OR13G1 rs1151640 Ile132Val no other genotyped snps IL10 rs3024498 rs3024508 rs1518110 rs3024489 rs3024510 rs1878672 rs3021094 rs3024488 rs3024497 rs3024493 rs3024491 rs1800872 rs3024496 rs3024507 rs3021093 rs1800895 rs5743628 rs3024492 rs3790622 rs1800871 rs3024495 rs2352792 rs3024490 rs1800894 rs5743627 rs1554286 rs2222202 rs1800896 rs3024509 rs5743626 (IL10-1082 A/G) rs3021098 rs3024494 rs1518111 rs3001099 rs9282740 rs3024506 rs5743625 AAT; SERPINA1 rs17824597 rs1243166 rs11846959 rs20546 rs17090693 rs1051052 rs17090719 rs11558261 rs1243168 rs1243165 rs2070709 rs709932 rs1884549 rs7142803 rs2753938 rs17751614 rs7144409 rs1243162 rs1243167 rs1243164 rs2749547 rs1884548 rs2073333 rs2753937 rs1885065 rs1243163 rs2854258 rs1884547 rs1802960 rs17580 (S allele) rs1884546 rs1303 rs1049800 rs9944117 rs13170 rs2230075 rs875989 rs12233 rs8350 rs877084 rs12077 rs6647 rs877083 rs1050520 rs11558264 rs877082 rs1050469 rs7141735 rs877081 rs1802961 rs7145047 rs11568814 rs1802959 rs2239652 rs9944155 rs2753939 rs7145770 rs11832 rs2749521 rs2239651 rs11628917 rs1802962 rs11558263 ICAM1 rs1799969 rs5030383 rs2735439 rs2569705 rs5493 rs281436 rs2569697 rs10402760 rs5030381 rs923366 rs2075742 rs2569706 rs5494 rs281437 rs2569698 rs2569707 rs3093033 rs3093030 rs11669397 rs2735441 rs5495 rs5030384 rs901886 rs2436545 rs1801714 rs5030385 rs885742 rs2436546 rs13306429 rs3810159 rs2569699 rs2916060 rs2071441 rs281438 rs1056538 rs2916059 rs5496 rs3093029 rs11549918 rs2916058 rs5497 rs2735442 rs2569700 rs2569708 rs13306430 rs2569693 rs2228615 rs12972990 rs5498 rs281439 (K469E) rs2569701 rs735747 rs5030400 rs281440 rs2569702 rs885743 rs2071440 rs2569694 rs2735440 rs5499 rs11575073 rs2569703 rs3093032 rs2569695 rs10418913 rs1057981 rs2075741 rs1056536 rs5500 rs11575074 rs2569704 rs5501 rs2569696 rs11673661 BAT1 rs10456058 rs3219190 rs3130057 rs2523507 rs2516485 rs1048885 rs1266079 rs2239525 rs2734572 rs11264 rs2844504 rs2239526 rs3093984 rs9267480 rs9267483 rs16899756 rs3130051 rs3093978 rs13211189 rs2239527 (−23 G/C) rs2734580 rs11543322 rs2734583 rs2523506 rs3130052 rs2516478 rs2516338 rs2523505 rs3130053 rs3130056 rs9267484 rs2239528 rs2734579 rs2734585 rs9380261 rs16899760 rs2734578 rs2516477 rs9267485 rs2523504 rs2734577 rs3853601 rs3130058 rs2844509 rs3130633 rs3093977 rs2516394 rs3130630 rs2907768 rs2734584 rs3093975 rs3130629 rs2516484 rs9267481 rs3093974 rs12662306 rs9267478 rs11796 rs1129640 rs9267487 rs2734588 rs3093948 rs933208 rs2251824 rs2516483 rs1055385 rs2071596 rs12215563 rs2516482 rs1055384 rs2516393 rs2071594 rs2516481 rs1055388 rs2523512 rs2071593 rs3130054 rs3131629 rs2523511 rs2239705 rs9394074 rs6915692 rs3219187 rs2523503 rs2516480 rs3131628 rs2071595 rs2523502 rs2259435 rs6915573 rs2239709 rs3093983 rs3093976 rs2516473 rs2286712 rs7753431 rs9501148 rs13206927 rs2516475 rs2523510 rs2734587 rs2516474 rs2269476 rs3093982 rs2471826 rs12665489 rs2734586 rs2734582 rs11757236 rs3130055 rs929138 rs12665501 rs3093981 rs2075581 rs12178599 rs3093980 rs2734581 rs2079170 rs2075582 rs2075580 rs2523508 rs3093979 rs9267482 rs7738430 rs3115537 rs10456396 rs3130059 NOS3 rs2373962 rs2566519 rs2853797 rs2373961 rs3918157 rs13311166 rs6951150 rs3918158 rs13310774 rs13238512 rs3918159 rs2853798 rs10247107 rs2566516 rs11974098 rs10276930 rs3918225 rs3918166 rs10277237 rs3918160 rs3730001 rs12703107 rs1800779 rs3918167 rs6946340 rs2243311 rs3918168 rs6946091 rs3918161 rs3918169 rs6946415 rs10952298 rs3918170 rs10952296 rs2070744 rs3793342 rs13309715 rs3918226 rs3793341 rs10952297 rs3918162 rs1549758 rs7784943 rs3918163 rs1007311 rs11771443 rs3918164 rs9282803 rs2243310 rs3918165 rs9282804 rs1800783 rs1800781 rs1799983 rs3918155 (Asp298Glu) rs13310854 rs3918156 rs13310763 SOD3 rs1799895; Arg213Gly within recombination hotspot PAI-1 rs6972498 rs7788533 rs2227707 rs12536798 rs6975620 rs2227631 rs6959121 rs6956010 rs1799768 rs17135252 (−675/−668 4G/5G) rs12534508 rs4729662 rs4729664 rs11770439 rs2527316 rs4727479 rs2854235 rs4729663 rs10228765 rs6950982 rs2854225 rs6465787 rs2854226 MIP1A rs8075808 rs1719126 rs4995343 rs17616714 rs5023530 rs4995344 rs7214787 rs5023529 rs4995345 rs9903603 rs5023528 rs4995346 rs1634486 rs5023527 rs9972917 rs7213813 rs1396785 rs1634497 rs8075709 rs2522124 rs7406518 rs1634488 rs2522125 rs1634498 rs1634489 rs764871 rs8076279 rs3859285 rs764872 rs1634499 rs3859286 rs2376461 rs17679109 rs3859287 rs2011959 rs9972960 rs1634490 rs1719127 rs1634500 rs17616756 rs3169944 rs1634501 rs5022560 rs1049203 rs17617023 rs2136430 rs8951 rs1634502 rs4319819 rs1049200 rs17617047 rs6505505 rs16971943 rs8068313 rs1620728 rs1049199 rs12602397 rs4302099 rs3210166 rs1634503 rs4319820 rs1063340 rs2687498 rs1634491 rs1049195 rs16971970 rs4506953 rs1049191 rs12452083 rs1634492 rs16971944 rs5011009 rs1634493 rs8070375 rs4636955 rs4309452 rs1049188 rs1626203 rs5015795 rs16971946 rs9900984 rs1851503 rs5029406 rs12937093 rs1719209 rs5029407 rs12937627 rs16971936 rs1049131 rs1719135 rs16971937 rs1049121 rs1719136 rs1634494 rs1049114 rs1634504 rs9893539 rs5029408 rs1634505 rs12601899 rs5029409 rs11658357 rs9916016 rs5029410 rs1634506 rs1719123 rs1719130 rs16971972 rs16971938 rs6505506 rs9913910 rs1879917 rs6505507 rs1634507 rs1719124 rs1719131 rs17679271 rs7406217 rs1130371 rs8072326 rs7406596 rs16971957 rs2072091 rs7406597 rs1851501 rs1634508 rs7502900 rs1719133 rs7220510 rs7222527 rs1634495 rs1719134 rs2188973 rs16971960 rs2188974 (+459 C/T) rs4995339 rs7222850 rs4995340 rs7222217 rs4995341 rs1719125 rs4995342 MMP7 rs14983 rs11225305 rs12289943 rs2847530 rs12419959 rs12788028 rs7926218 rs12419977 rs10895308 rs2187364 rs11225306 rs2408391 rs2156528 rs11225307 rs11820758 rs17098292 rs10502001 rs880197 rs17352054 rs12289049 rs1943778 rs11225303 rs10750646 rs11827824 rs12288254 rs10502002 rs1943779 rs7933135 rs11225308 rs7926470 rs12575975 rs11225304 rs11225309 rs17098295 rs17098317 rs6590970 rs10895306 rs1996352 rs10895307 rs12418158 rs2408390 rs2701982 rs17881472 rs12419636 rs17880821 (−181 A/G) rs17098306 rs4543946 rs12285347 rs17098318 Cathepsin G rs9671740 rs34792401 rs12588201 rs10148261 rs6573865 rs8007970 rs11848310 rs35614744 rs35345293 rs4537944 rs2332397 rs8012655 rs12889110 rs10311660 rs4981537 rs36079901 rs2332398 rs1956907 rs12587099 rs12147842 rs4981538 rs9989246 rs3891906 rs1956906 rs12879629 rs9671474 rs4981539 rs9989184 rs3891905 rs35316440 rs35776728 rs1756602 rs4981540 rs34712519 rs11851298 rs28778409 rs35270658 rs11157885 rs34432073 rs12100969 rs3861508 rs8008954 rs34377408 rs10143176 rs35884608 rs10144984 rs7142675 rs2093256 rs34310125 rs12436232 rs4981541 rs10145731 rs11301449 rs11158781 rs35426278 rs5007574 rs9646161 rs28806511 rs28441642 rs7157694 rs2216900 rs28878775 rs4982959 rs10145286 rs2011607 rs8005739 rs12435455 rs35112976 rs11158761 rs28803584 rs11158778 rs7143951 rs10138356 rs34065379 rs4632067 rs9652365 rs11845858 rs7144090 rs4644778 rs12433770 rs34318040 rs12888328 rs2224426 rs7144096 rs11850630 rs11159232 rs8010555 rs12887710 rs4982968 rs7144104 rs34841597 rs12882370 rs10148816 rs8006887 rs35704637 rs34651242 rs12879894 rs36126615 rs10133351 rs8007599 rs1951132 rs10136912 rs4375584 rs9672023 rs12890682 rs9652294 rs1951131 rs9323523 rs800849 rs9944068 rs4553550 rs7155992 rs1951130 rs28722668 rs34042254 rs9944069 rs4537943 rs12888151 rs1951129 rs35959655 rs34545435 rs1956918 rs12433996 rs34436261 rs3079309 rs34997518 rs12885502 rs1956917 rs34092671 rs36100678 rs34634241 rs17257069 rs12885756 rs1956916 rs8005125 rs35239717 rs11849152 rs6573871 rs12885748 rs761988 rs35584604 rs12587746 rs1956911 rs17105013 rs12885747 rs927281 rs1956915 rs34035545 rs12888496 rs28479407 rs12885233 rs12434912 rs10873216 rs4420452 rs1956910 rs12100907 rs34449575 rs28656464 rs34656084 rs721134 rs1956909 rs11158791 rs34780137 rs35275136 rs34416904 rs10130107 rs12588702 rs1956912 rs12886566 rs4982956 rs28496049 rs3901388 rs2332399 rs1956908 rs11850400 rs7148705 rs12589666 rs35220969 rs1951128 rs1304909 rs12882368 rs2007323 rs7151899 rs3861506 rs2332400 rs8021299 rs12882089 rs2007316 rs7149913 rs3861507 rs28768164 rs7155452 rs12896244 rs927278 rs7149925 rs3905107 rs10144882 rs2332401 rs35106724 rs8007723 rs7156977 rs1956914 rs1951127 rs8007285 rs35193389 rs6573850 rs4982960 rs1956913 rs8022028 rs11849224 rs12432795 rs34858090 rs7141080 rs987630 rs10131084 rs6573874 rs12432796 rs3079301 rs33993912 rs987629 rs10139948 rs12587351 rs34281648 rs35839512 rs4982961 rs987628 rs10139332 rs12587425 rs800850 rs34614283 rs12878586 rs11158770 rs1951125 rs4982969 rs34013113 rs4982957 rs8004636 rs932617 rs33995132 rs12587539 rs11851718 rs2208447 rs10130100 rs932616 rs1951124 rs10601342 rs12433789 rs7146705 rs11849539 rs1885106 rs8007117 rs35533698 rs13379195 rs9806075 rs35778376 rs8008866 rs8006658 rs10601343 rs13379433 rs34657109 rs8008632 rs4982964 rs34042582 rs4592564 rs4287482 rs7151943 rs11520369 rs4982965 rs34002761 rs8019787 rs34264349 rs7150627 rs34079088 rs4982966 rs8007445 rs1885597 rs4417480 rs4981536 rs4982962 rs10134629 rs34071722 Asn 125Ser rs2792215 rs4982958 rs4981542 rs8003038 rs12890487 rs17105289 rs10313155 rs11351813 rs4982963 rs8017569 rs12890488 rs34281853 rs34640640 rs10712328 rs36074365 rs10137473 rs12890064 rs2070697 CX3CR1 rs4234139 rs11707528 rs17038647 rs2669850 rs4676621 rs34570795 rs11129819 rs17793056 rs4676622 rs34841495 rs11129820 rs2669851 rs12491311 rs6599018 rs9826296 rs2853714 rs34980214 rs11709600 rs17038663 rs36040453 rs35840437 rs34991361 rs7636125 rs34864276 rs35425914 rs9847920 rs11710546 rs13088991 rs13078589 rs17038640 rs17038674 rs13099085 rs9869871 rs1050592 rs34681148 rs10695501 rs3732378 rs35007101 rs35540291 rs3732379 rs6790767 rs4016736 (I249V) rs4986872 rs9882352 rs11711922 rs17038679 rs938206 rs4676623 rs3732380 rs938207 rs34481570 rs7645269 rs11706384 rs4676487 rs4271863 rs11711391 rs35291973 rs35502141 rs7649301 rs1877563 rs34743375 rs17038638 rs11713282 rs12634272 rs13315491 rs17038645 rs34139145 NOD2 rs6596 rs34430742 rs1078327 rs8061960 rs12929234 rs17314544 rs35435054 rs4785224 rs5743274 rs34192073 rs34552113 rs17223195 rs35581802 rs5743261 rs35422070 rs2066847 rs35899583 rs13337656 rs8054275 rs5743262 rs1861759 rs5743293 rs12324931 rs13338860 rs13339019 rs5743263 rs5743275 rs5743294 rs3135501 rs12599914 rs35973532 rs8046608 rs5743276 rs34829738 rs3135502 rs35234675 rs1131716 rs35378728 rs2066844 rs2357791 rs3135503 rs16948819 rs17846633 rs5743264 rs5743277 rs7359452 rs34683241 rs7200370 rs34428900 rs5743265 rs35285618 rs7203344 rs11861521 rs4785226 rs2302723 rs5743266 rs5743278 rs5743295 rs4785450 rs11646600 rs7195707 rs2076752 rs6413461 rs5743296 rs11862710 rs17223257 rs9888893 rs5743267 rs3813758 rs35980453 rs11862720 rs11865799 rs7191692 rs8061316 rs5743279 rs3135499 rs1990752 rs35072258 rs10600956 rs8061636 rs5743280 rs5743297 rs11864090 rs11866167 rs35509283 rs34456998 rs5743281 rs5743298 rs34464167 rs10451132 rs12448380 rs16948754 rs5743282 rs5743299 rs34620046 rs3064638 rs12445637 rs34627107 rs4785225 rs3135500 rs8062105 rs2066852 rs7202124 rs35085911 rs16948773 rs5743300 rs34321598 rs2302759 rs2270369 rs34281847 rs9931711 rs8056611 rs16948792 rs7194167 rs2270368 rs7206340 rs17313265 rs35111385 rs34741614 rs34233862 rs35929558 rs36034720 rs34912053 rs2357792 rs11859047 rs12444259 rs34828195 rs35701609 rs35263569 rs12600253 rs11863594 rs28705891 rs2287195 rs2076753 rs10680678 rs12598306 rs11864698 rs28654666 rs2066848 rs34936594 rs35322998 rs7205423 rs1477176 rs11382774 rs36094725 rs35095295 rs11646168 rs718226 rs35967774 rs34593836 rs11336436 rs34684955 rs35431588 rs34963149 rs2066851 rs2160683 rs10709169 rs2067085 rs9925315 rs11646242 rs1592639 rs3743781 rs4785223 rs16948755 rs5743284 rs35151581 rs9925070 rs9646285 rs9926569 rs34939799 rs5743285 rs7498888 rs11863544 rs16948829 rs9939349 rs2111235 rs751271 rs5816718 rs3064635 rs34088926 rs28651300 rs35617724 rs748855 rs11323644 rs12933741 rs16948836 rs8062727 rs2111234 rs1861758 rs8060765 rs12933742 rs17314948 rs8044354 rs7190413 rs13332952 rs16948789 rs11863916 rs34262697 rs8043770 rs7206582 rs7198979 rs17313747 rs5816721 rs7184210 rs10459815 rs8045009 rs1861757 rs5816719 rs11859674 rs34917190 rs9302752 rs6500328 rs7203691 rs35360138 rs1420873 rs34015619 rs13331872 rs7500036 rs5743286 rs5816720 rs8053457 rs34678551 rs1420685 rs8057341 rs5743287 rs34562455 rs6500329 rs35812259 rs5816713 rs35863026 rs11319364 rs3064634 rs7500289 rs6500333 rs33925268 rs12918060 rs34103974 rs751919 rs12924216 rs17223592 rs4027240 rs7204911 rs10521209 rs3743782 rs1548989 rs11866769 rs35554928 rs7500826 rs2066845 rs11353661 rs16948808 rs1861762 Gly 881 Arg G/C) rs2004804 rs4785449 rs5743288 rs7199842 rs4283227 rs7187386 rs12448915 rs12922299 rs5743289 rs1362698 rs1420872 rs8051573 rs5816714 rs11649521 rs8063130 rs2216313 rs4785451 rs35224296 rs5816715 rs13339578 rs2076756 rs11364818 rs6500331 rs3922267 rs34609432 rs17221417 rs12920425 rs10655305 rs11644525 rs3087557 rs11297087 rs13331327 rs12920040 rs35620436 rs35189427 rs1054987 rs34919724 rs11642482 rs12920558 rs11451496 rs16948810 rs9635531 rs34746653 rs11642646 rs11326665 rs1548990 rs16948811 rs11374168 rs34550909 rs17312836 rs11292073 rs7195766 rs16948813 rs33995398 rs5816716 rs5743268 rs11423748 rs9940175 rs6500332 rs4785452 rs34235838 rs5743269 rs12919099 rs8060598 rs17222902 rs4785453 rs3064632 rs5743270 rs12920721 rs7198188 rs1420871 rs4785227 rs1981760 rs12925051 rs2076755 rs7187352 rs2302760 rs4785454 rs8063362 rs12929565 rs5743290 rs34564491 rs7192397 rs4785455 rs9933594 rs13380733 rs5743291 rs12599808 rs17314341 rs3064640 rs1362632 rs13380741 rs11642651 rs11271535 rs12597446 rs13332720 rs12926429 rs11647841 rs1861756 rs7200535 rs3785141 rs16948850 rs35831008 rs34409335 rs749910 rs13336419 rs13333006 rs6500334 rs4785448 rs34133110 rs34333043 rs3785142 rs3785140 rs5816722 rs11647143 rs10451131 rs2066846 rs7342808 rs9938976 rs3064642 rs34981889 rs2066842 rs5816717 rs7342715 rs8061821 rs6500335 rs7194886 rs35090774 rs4990643 rs28454013 rs8062540 rs16948851 rs34231814 rs5743271 rs1077861 rs7197362 rs16948817 rs3135504 rs11645448 rs7498256 rs34810706 rs12934597 rs8047910 rs7189846 rs35832802 rs5743272 rs5743292 rs12930153 rs4027241 rs7205760 rs5743259 rs5743273 rs9921146 rs12934724 rs34145774 rs8049077 rs5743260 rs2076754 rs11645386 rs12934730 rs35896215 rs1861761 rs2066850 rs2066843 rs7187857 rs12929222 rs2111435 rs12925755 TIMP1 rs2858769 rs13440654 rs2097423 rs35754459 rs34026683 rs5952438 rs35510014 rs17147652 rs5906436 rs2854412 rs1984392 rs7064051 rs34644595 rs3211164 rs4824621 rs34987183 rs35777532 rs12010140 rs10701204 rs35895268 rs4824622 rs34465989 rs28764016 rs12559303 rs35338820 rs28764017 rs34324592 rs1050151 rs1043428 rs5953061 rs34865437 rs5953060 rs5953062 rs35946819 rs4898 rs13441207 (372 T/C) rs34663452 rs35209437 rs5953063 rs1050175 rs6609533 rs5906437 rs10066 rs34220495 rs3921110 rs35136843 rs1803571 rs34949562 rs2855135 rs11551797 rs6520281 rs2854414 rs17850165 rs34910886 rs2855136 rs1062849 rs5953065 rs2854415 rs2070584 rs9887335 rs2854416 rs6609534 rs34207832 rs2854417 rs34478552 rs35891328 rs723556 rs5906434 rs12007301 rs12394306 rs6520278 rs6609539 rs35093912 rs6520279 rs5953066 rs5953059 rs7886171 rs6608733 rs34576985 rs12556415 rs4824424 rs6609532 rs5905614 rs4824623 rs4282692 rs5905615 rs6608734 rs13440825 rs5906435

INDUSTRIAL APPLICATION

The present invention is directed to methods for assessing a subject's risk of developing ACS. The methods comprise the analysis of polymorphisms herein shown to be associated with increased or decreased risk of developing ACS, or the analysis of results obtained from such an analysis. The use of polymorphisms herein shown to be associated with increased or decreased risk of developing ACS in the assessment of a subject's risk are also provided, as are nucleotide probes and primers, kits, and microarrays suitable for such assessment. Methods of treating subjects having the polymorphisms herein described are also provided. Methods for screening for compounds able to modulate the expression of genes associated with the polymorphisms herein described are also provided.

All patents, publications, scientific articles, and other documents and materials referenced or mentioned herein are indicative of the levels of skill of those skilled in the art to which the invention pertains, and each such referenced document and material is hereby incorporated by reference to the same extent as if it had been incorporated by reference in its entirety individually or set forth herein in its entirety. Applicants reserve the right to physically incorporate into this specification any and all materials and information from any such patents, publications, scientific articles, web sites, electronically available information, and other referenced materials or documents.

The specific methods described herein are representative of various embodiments or preferred embodiments and are exemplary only and not intended as limitations on the scope of the invention. Other objects, aspects, examples and embodiments will occur to those skilled in the art upon consideration of this specification, and are encompassed within the spirit of the invention as defined by the scope of the claims. It will be readily apparent to one skilled in the art that varying substitutions and modifications can be made to the invention disclosed herein without departing from the scope and spirit of the invention. The invention illustratively described herein suitably can be practiced in the absence of any element or elements, or limitation or limitations, which is not specifically disclosed herein as essential. Thus, for example, in each instance herein, in embodiments or examples of the present invention, any of the terms “comprising”, “consisting essentially of”, and “consisting of” may be replaced with either of the other two terms in the specification, thus indicating additional examples, having different scope, of various alternative embodiments of the invention. Also, the terms “comprising”, “including”, containing”, etc. are to be read expansively and without limitation. The methods and processes illustratively described herein suitably may be practiced in differing orders of steps, and that they are not necessarily restricted to the orders of steps indicated herein or in the claims. It is also that as used herein and in the appended claims, the singular forms “a,” “an,” and “the” include plural reference unless the context clearly dictates otherwise. Thus, for example, a reference to “a host cell” includes a plurality (for example, a culture or population) of such host cells, and so forth. Under no circumstances may the patent be interpreted to be limited to the specific examples or embodiments or methods specifically disclosed herein. Under no circumstances may the patent be interpreted to be limited by any statement made by any Examiner or any other official or employee of the Patent and Trademark Office unless such statement is specifically and without qualification or reservation expressly adopted in a responsive writing by Applicants.

The terms and expressions that have been employed are used as terms of description and not of limitation, and there is no intent in the use of such terms and expressions to exclude any equivalent of the features shown and described or portions thereof, but it is recognized that various modifications are possible within the scope of the invention as claimed. Thus, it will be understood that although the present invention has been specifically disclosed by preferred embodiments and optional features, modification and variation of the concepts herein disclosed may be resorted to by those skilled in the art, and that such modifications and variations are considered to be within the scope of this invention. 

1. A method of determining a subject's risk of developing acute coronary syndrome (ACS), comprising analysing a sample from said subject for the presence or absence of at least one polymorphism selected from the group consisting of: −1903 A/G in the gene encoding Chymase 1 (CMA1); −82 A/G in the gene encoding Matrix metalloproteinase 12 (MMP12); Ser52Ser (223 C/T) in the gene encoding Fibroblast growth factor 2 (FGF2); Q576R AJG in the gene encoding Interleukin 4 receptor alpha (IL4RA); HOM T2437C in the gene encoding Heat Shock Protein 70 (HSP 70); 874 AJT in the gene encoding Interferon γ (IFNG); −589 C/T in the gene encoding Interleukin 4 (IL-4); −1084 A/G (−1082) in the gene encoding Interleukin 10 (IL-10); Arg213Gly C/G in the gene encoding Superoxide dismutase 3 (SOD3); 459 C/T Intron I in the gene encoding Macrophage inflammatory protein 1 alpha (MIP1A); Asn 125 Ser A/G in the gene encoding Cathepsin G; I249V C/T in the gene encoding Chemokine (CX3C motif) receptor 1 (CX3CR1); Gly 881 Arg G/C in the gene encoding Caspase (NOD2); or 372 T/C in the gene encoding Tissue inhibitor of metalloproteinase 1 (TIMP1); −509 C/T in the gene encoding Transforming growth factor β1 (TGFB1); Thr26Asn AJC in the gene encoding Lymphotoxin α (LTA); Asp299Gly A/G in the gene encoding Toll-like Receptor 4 (TLR4); Thr399Ile C/T in the gene encoding TLR4; −63 T/A in the gene encoding Nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor-like 1 (NFKBIL1); 1630 Ins/Del (AACTT/Del) in the gene encoding Platelet derived growth factor receptor alpha (PDGFRA); −1607 1G/2G (Del/G) in the gene encoding Matrix metalloproteinase 1 (MMP1); 12 IN 5 C/T in the gene encoding Platelet derived growth factor alpha (PDGFA); −588 C/T in the gene encoding Glutamate-cysteine ligase modifier subunit (GCLM); Ile132Val A/G in the gene encoding Olfactory receptor analogue OR13G1 (OR13G1); Glu288Val A/T (M7S) in the gene encoding alpha 1-antitrypsin (α1-AT); K469E A/G in the gene encoding Intracellular adhesion molecule 1 (ICAM1); −23 C/G in the gene encoding HLA-B associated transcript 1 (BAT1); Glu298Asp G/T in the gene encoding Nitric Oxide synthase 3 (NOS3); −668 4G/5G in the gene encoding Plasminogen activator inhibitor 1 (PAI-I); −181 A/G in the gene encoding Matrix metalloproteinase 7 (MMP7); and one or more polymorphisms which are in linkage disequilibrium with any one of said at least one polymorphism; wherein the presence or absence of said at least one polymorphism is indicative of the subject's risk of developing ACS. 2-4. (canceled)
 5. The method according to claim 1, wherein the presence of at least one polymorphism is indicative of a reduced risk of developing ACS, and wherein said at least one polymorphism is selected from the group consisting of: the Ser52Ser (223 C/T) CC genotype in the gene encoding FGF2; the Q576R A/G AA genotype in the gene encoding IL4RA; the Thr26Asn A/C CC genotype in the gene encoding LTA; the Horn T2437C CC or CT genotype in the gene encoding HSP70; the Asp299Gly A/G AG or GG genotype in the gene encoding TLR4; the Thr399Ile C/T CT or TT genotype in the gene encoding TLR4; the 874 A/T TT genotype in the gene encoding IFNG; the −63 T/A AA genotype in the gene encoding NFKBIL1; the −1630 Ins/Del (AACTT/Del) Ins/Del or Del/Del genotype in the gene encoding PDGFRA; the −589 C/T CT or TT genotype in the gene encoding IL-4; the −588 C/T CC genotype in the gene encoding GCLM; the −1084 A/G GG genotype in the gene encoding IL-10; the K469E A/G AA genotype in the gene encoding ICAM1; the −23 C/G GG genotype in the gene encoding BAT1; the Glu298Asp G/T GG genotype in the gene encoding NOS3; the Arg213Gly C/G CG or GG genotype in the gene encoding SOD3; the −668 4G/5G 5G5G genotype in the gene encoding PAI-I; the −181 A/G GG genotype in the gene encoding MMP7; the Asn 125 Ser AG or GG genotype in the gene encoding Cathepsin G; and 372 T/C TT genotype in the gene encoding TIMP1.
 6. The method according to claim 1, wherein the presence of at least one polymorphism is indicative of an increased risk of developing ACS and wherein said at least one polymorphism is selected from the group consisting of: the −1903 A/G GG genotype in the gene encoding CMA1; the −509 C/T CC genotype in the gene encoding TGFB1; the −82 A/G GG genotype in the gene encoding MMP12; the Ser52Ser (223 C/T) CT or TT genotype in the gene encoding FGF2; the Q576R A/G GG genotype in the gene encoding IL4RA; the Horn T2437C TT genotype in the gene encoding HSP70; the Asp299Gly A/G AA genotype in the gene encoding TLR4; the Thr399Ile C/T CC genotype in the gene encoding TLR4; the −1630 Ins/Del (AACTT/Del) Ins Ins (AACTT AACTT) genotype in the gene encoding PDGFRA; the −589 C/T CC genotype in the gene encoding IL4; the −1607 1G/2G (Del/G) Del Del (IG IG) genotype in the gene encoding MMP1; the 12 IN5 C/T TT genotype in the gene encoding PDGFA; the −588 C/T CT or TT genotype in the gene encoding GCLM; the Ile132Val A/G AA genotype in the gene encoding OR13G1; the Glu288Val A/T (M/S) AT or TT (MS or SS) genotype in the gene encoding α1-AT; the +459 C/T Intron 1 CT or TT genotype in the gene encoding MIP1A; the Asn 125 Ser AA genotype in the gene encoding Cathepsin G; the I249V TT genotype in the gene encoding CX3CR1; the GIy 881 Arg G/C CC or CG genotype in the gene encoding NOD2; and the 372 T/C CC genotype in the gene encoding TIMP1.
 7. A method of assessing a subject's risk of developing ACS, said method comprising the steps: (i) determining the presence or absence of at least one protective polymorphism associated with a reduced risk of developing ACS and (ii) in the absence of at least one protective polymorphisms, determining the presence or absence of at least one susceptibility polymorphism associated with an increased risk of developing ACS; wherein the presence of one or more of said protective polymorphisms is indicative of a reduced risk of developing ACS, and the absence of at least one protective polymorphism in combination with the presence of at least one susceptibility polymorphism is indicative of an increased risk of developing ACS.
 8. The method according to claim 7 wherein said at least one protective polymorphism is selected from the group consisting of: the Ser52Ser (223 C/T) CC genotype in the gene encoding FGF2; the Q576R A/G AA genotype in the gene encoding IL4RA; the Thr26Asn AJC CC genotype in the gene encoding LTA; the Horn T2437C CC or CT genotype in the gene encoding HSP70; the Asp299Gly A/G AG or GG genotype in the gene encoding TLR4; the Thr399Ile C/T CT or TT genotype in the gene encoding TLR4; the 874 A/T TT genotype in the gene encoding IFNG; the −63 T/A AA genotype in the gene encoding NFKBIL1; the −1630 Ins/Del (AACTT/Del) Ins/Del or Del/Del genotype in the gene encoding PDGFRA; the −589 C/T CT or TT genotype in the gene encoding IL-4; the −588 C/T CC genotype in the gene encoding GCLM; the −1084 A/G GG genotype in the gene encoding IL-10; the K469E A/G AA genotype in the gene encoding ICAM1; the −23 C/G GG genotype in the gene encoding BAT1; the Glu298Asp G/T GG genotype in the gene encoding NOS3; the Arg213Gly C/G CG or GG genotype in the gene encoding SOD3; the −668 4G/5G 5G5G genotype in the gene encoding PAI-I; the −181 A/G GG genotype in the gene encoding MMP7; the Asn 125 Ser AG or GG genotype in the gene encoding Cathepsin G; and 372 T/C TT genotype in the gene encoding TIMP.
 9. The method according to claim 7, wherein said at least one susceptibility polymorphism is a genotype selected from the group consisting of: the −1903 A/G GG genotype in the gene encoding CMA1; the −509 C/T CC genotype in the gene encoding TGFB1; the −82 A/G GG genotype in the gene encoding MMP12; the Ser52Ser (223 C/T) CT or TT genotype in the gene encoding FGF2; the Q576R A/G GG genotype in the gene encoding IL4RA; the Horn T2437C TT genotype in the gene encoding HSP70; the Asp299Gly A/G AA genotype in the gene encoding TLR4; the Thr399Ile C/T CC genotype in the gene encoding TLR4; the −1630 Ins/Del (AACTT/Del) Ins Ins (AACTT AACTT) genotype in the gene encoding PDGFRA; the −589 C/T CC genotype in the gene encoding IL4; the −1607 1G/2G (Del/G) Del Del (IG IG) genotype in the gene encoding MMP1; the 12 IN5 C/T TT genotype in the gene encoding PDGFA; the −588 C/T CT or TT genotype in the gene encoding GCLM; the Ile132Val A/G AA genotype in the gene encoding OR13G1; the Glu288Val A/T (M/S) AT or TT (MS or SS) genotype in the gene encoding α1-AT; the +459 C/T Intron 1 CT or TT genotype in the gene encoding MIP1A; the Asn 125 Ser AA genotype in the gene encoding Cathepsin G; the I249V TT genotype in the gene encoding CX3CR1; the GIy 881 Arg G/C CC or CG genotype in the gene encoding NOD2; and the 372 T/C CC genotype in the gene encoding TIMP.
 10. The method according to claim 7, wherein the presence of two or more protective polymorphisms irrespective of the presence of one or more susceptibility polymorphisms is indicative of reduced risk of developing ACS.
 11. The method according to claim 7, wherein in the absence of a protective polymorphism the presence of one or more susceptibility polymorphisms is indicative of an increased risk of developing ACS.
 12. The method according to claim 7, wherein the presence of two or more susceptibility polymorphisms is indicative of an increased risk of developing ACS.
 13. (canceled)
 14. The method according to claim 1, wherein said method further comprises: performing an analysis of at least one epidemiological risk factors.
 15. A method of determining a subject's risk of developing acute coronary syndrome (ACS), said method comprising the steps: (i) obtaining the result of one or more genetic tests of a sample from said subject; and (ii) analysing the result for the presence or absence of at least one polymorphism selected from the group consisting of: −1903 AJG in the gene encoding Chymase 1 (CMA1); −82 AJG in the gene encoding Matrix metalloproteinase 12 (MMP12); Ser52Ser (223 C/T) in the gene encoding Fibroblast growth factor 2 (FGF2); Q576R AJG in the gene encoding Interleukin 4 receptor alpha (IL4RA); HOM T2437C in the gene encoding Heat Shock Protein 70 (HSP 70); 874 AJT in the gene encoding Interferon γ (IFNG); −589 C/T in the gene encoding Interleukin 4 (IL-4); −1084 AJG (−1082) in the gene encoding Interleukin 10 (IL-10); Arg213Gly C/G in the gene encoding Superoxide dismutase 3 (SOD3); 459 C/T Intron I in the gene encoding Macrophage inflammatory protein 1 alpha (MIP1A); Asn 125 Ser A/G in the gene encoding Cathepsin G; I249V C/T in the gene encoding Chemokine (CX3C motif) receptor 1 (CX3CR1); GIy 881 Arg G/C in the gene encoding Caspase (NOD2); 372 T/C in the gene encoding Tissue inhibitor of metalloproteinase 1 (TIMP1); and one or more polymorphisms which are in linkage disequilibrium with any one said at least one polymorphism; wherein a result indicating the presence or absence of said at least one polymorphism is indicative of the subject's risk of developing ACS.
 16. The method according to claim 15, wherein a result indicating the presence of at least one polymorphism is indicative of a reduced risk of developing ACS, and wherein said at least one polymorphism is selected from the group consisting of: the Ser52Ser (223 C/T) CC genotype in the gene encoding FGF2; the Q576R A/G AA genotype in the gene encoding IL4RA; the Horn T2437C CC or CT genotype in the gene encoding HSP70; the 874 A/T TT genotype in the gene encoding IFNG; the −589 C/T CT or TT genotype in the gene encoding IL-4; the −1084 A/G GG genotype in the gene encoding IL-10; the Arg213Gly C/G CG or GG genotype in the gene encoding SOD3; the Asn 125 Ser AG or GG genotype in the gene encoding Cathepsin G; and 372 T/C TT genotype in the gene encoding TIMP1.
 17. The method according to claim 15 wherein a result indicating the presence of at least one polymorphism is indicative of a reduced risk of developing ACS, and wherein said at least one polymorphism is selected from the group consisting of: the −1903 A/G GG genotype in the gene encoding CMA1; the −82 A/G GG genotype in the gene encoding MMP12; the +459 C/T Intron 1 CT or TT genotype in the gene encoding MIP1A; the Asn 125 Ser AA genotype in the gene encoding Cathepsin G; the I249V TT genotype in the gene encoding CX3CR1; the GIy 881 Arg G/C CC or CG genotype in the gene encoding NOD2; and the 372 T/C CC genotype in the gene encoding TIMP1. 18-26. (canceled)
 27. A method for screening for compounds that modulate the expression and/or activity of a gene, wherein the expression and/or activity of said gene is upregulated or down-regulated when associated with a susceptibility or protective polymorphism selected from the group defined in claim 2 or claim 3, said method comprising the steps of: contacting a candidate compound with a cell comprising a susceptibility or protective polymorphism which has been determined to be associated with the upregulation or downregulation of expression and/or activity of a gene; and measuring a level of expression and/or activity of said gene following contact with said candidate compound, wherein a change in the level of expression and/or activity of said gene after the contacting step as compared to before the contacting step is indicative of the ability of the candidate compound to modulate the expression and/or activity of said gene.
 28. The method according to claim 27, wherein said cell is a human vascular cell which has been pre-screened to confirm the presence of said polymorphism.
 29. (canceled)
 30. The method according to claim 27, wherein said cell comprises a susceptibility polymorphism associated with upregulation of expression and/or activity of said gene and said screening is for candidate compounds which downregulate expression and/or activity of said gene.
 31. The method according to claim 27, wherein said cell comprises a susceptibility polymorphism associated with downregulation of expression and/or activity of said gene and said screening is for candidate compounds which upregulate expression and/or activity of said gene.
 32. The method according to claim 27, wherein said cell comprises a protective polymorphism associated with upregulation of expression and/or activity of said gene and said screening is for candidate compounds which further upregulate expression and/or activity of said gene.
 33. The method according to claim 27, wherein said cell comprises a protective polymorphism associated with downregulation of expression and/or activity of said gene and said screening is for candidate compounds which further downregulate expression and/or activity of said gene. 34-40. (canceled)
 41. A method of assessing the likely responsiveness of a subject predisposed to or diagnosed with acute coronary syndrome (ACS) to a prophylactic or therapeutic treatment, which treatment involves restoring the physiologically active concentration of a product of gene expression to be within a range which is normal for the age and sex of the subject, which method comprises detecting in said subject the presence or absence of a susceptibility polymorphism selected from the group defined in claim 3 which when present either upregulates or downregulates expression of said gene such that the physiological active concentration of the expressed gene product is outside said normal range, wherein the detection of the presence of said polymorphism is indicative of the subject likely responding to said treatment. 42-50. (canceled) 